1
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Margonato D, Enriquez-Sarano M, Wang C, Phichaphop A, Okada A, Koike H, Fukui M, Hamid N, Lesser J, Sorajja P, Bapat V, Cavalcante JL. Tricuspid Valve Leaflets-Lead Interaction: Adjunctive Role of Functional Cardiac Computed Tomography for Clinical Decision Making. JACC Case Rep 2024; 29:102372. [PMID: 38774636 PMCID: PMC11107353 DOI: 10.1016/j.jaccas.2024.102372] [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: 02/04/2024] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 05/24/2024]
Abstract
The diagnostic approach toward the management of cardiac implantable electronic device-related tricuspid regurgitation is challenging and undefined. Functional cardiac computed tomography angiography provides a complementary role to echocardiography in the evaluation of lead-leaflet interaction which can help the clinical decision-making process, as presented in this case series.
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Affiliation(s)
- Davide Margonato
- Cardiovascular Imaging Research Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Milan, Italy
| | | | - Cheng Wang
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Asa Phichaphop
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hideki Koike
- Cardiovascular Imaging Research Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Miho Fukui
- Cardiovascular Imaging Research Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Nadira Hamid
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - John Lesser
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L. Cavalcante
- Cardiovascular Imaging Research Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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2
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Lin D, Cavalcante J, Cheng V, Lesser J. Exertional Angina in a Young Woman Caused by Large Cardiac Paraganglioma. JACC Case Rep 2024; 29:102209. [PMID: 38379646 PMCID: PMC10874983 DOI: 10.1016/j.jaccas.2023.102209] [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: 11/04/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 02/22/2024]
Abstract
Coronary ischemia is uncommon in patients in their third decade of life. We present a 21-year-old woman with classic exertional angina secondary to a large cardiac paraganglioma. Cardiac paragangliomas are rare extra-adrenal neuroendocrine tumors that arise from chromaffin cells. Cardiac symptoms can be related to catecholamine excess or anatomical compression.
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Affiliation(s)
- David Lin
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Part of Allina Health, Minneapolis, Minnesota, USA
| | - Joao Cavalcante
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Part of Allina Health, Minneapolis, Minnesota, USA
| | - Victor Cheng
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Part of Allina Health, Minneapolis, Minnesota, USA
| | - John Lesser
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Part of Allina Health, Minneapolis, Minnesota, USA
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3
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Voudris K, Lesser J, Sorajja P, Hamid N. 3-Dimensional Multiplanar Reconstruction With Transesophageal Echocardiography for Alcohol Septal Ablation. JACC Case Rep 2023; 24:102016. [PMID: 37869218 PMCID: PMC10589419 DOI: 10.1016/j.jaccas.2023.102016] [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: 03/02/2023] [Revised: 05/22/2023] [Accepted: 08/14/2023] [Indexed: 10/24/2023]
Abstract
This study described the first experience with 3-dimensional multiplanar reconstruction transesophageal echocardiography to guide percutaneous alcohol septal ablation. This study demonstrated that 3-dimensional transesophageal echocardiography multiplanar reconstruction allowed for simultaneous assessment of the targeted myocardial area from left ventricular base to apex, akin to imaging seen with spatial imaging with cardiac magnetic resonance. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Konstaninos Voudris
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - John Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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4
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Thaler C, Witt D, Casey S, Kelle AM, Garcia S, Lesser J, Han BK. Diagnostic Value of Computed Tomography Angiography for Infective Endocarditis After Right Ventricle Outflow Tract Repair. JACC Case Rep 2023; 23:102011. [PMID: 37954952 PMCID: PMC10635865 DOI: 10.1016/j.jaccas.2023.102011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 11/14/2023]
Abstract
Congenital heart disease patients with pulmonary valve replacement or right ventricle-pulmonary artery conduit have increased risk of pulmonary valve endocarditis. We present a 6-patient case series illustrating the diagnostic utility of computed tomography angiography to provide definitive visualization of pulmonary valve vegetation to aid in the diagnosis of endocarditis. (Level of Difficulty: Intermediate.).
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Affiliation(s)
| | - Dawn Witt
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Susan Casey
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Angela M. Kelle
- Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Santiago Garcia
- The Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA
| | - John Lesser
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
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5
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM, Mendes LA, Arrighi JA, Breinholt JP, Day J, Dec GW, Denktas AE, Drajpuch D, Faza N, Francis SA, Hahn RT, Housholder-Hughes SD, Khan SS, Kondapaneni MD, Lee KS, Lin CH, Hussain Mahar J, McConnaughey S, Niazi K, Pearson DD, Punnoose LR, Reejhsinghani RS, Ryan T, Silvestry FE, Solomon MA, Spicer RL, Weissman G, Werns SW. 2023 ACC/AHA/SCAI advanced training statement on interventional cardiology (coronary, peripheral vascular, and structural heart interventions): A report of the ACC Competency Management Committee. J Thorac Cardiovasc Surg 2023; 166:e73-e123. [PMID: 37269254 DOI: 10.1016/j.jtcvs.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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6
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. JACC Cardiovasc Interv 2023; 16:1239-1291. [PMID: 37115166 DOI: 10.1016/j.jcin.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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7
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. J Am Coll Cardiol 2023; 81:1386-1438. [PMID: 36801119 DOI: 10.1016/j.jacc.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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8
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Huie LC, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. Circ Cardiovasc Interv 2023; 16:e000088. [PMID: 36795800 DOI: 10.1161/hcv.0000000000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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9
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Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, Budoff M, Chinnaiyan K, Choi AD, Ghoshhajra B, Jacobs J, Koweek L, Lesser J, Maroules C, Rubin GD, Rybicki FJ, Shaw LJ, Williams MC, Williamson E, White CS, Villines TC, Blankstein R. CAD-RADS™ 2.0 - 2022 Coronary Artery Disease-Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI). JACC Cardiovasc Imaging 2022; 15:1974-2001. [PMID: 36115815 DOI: 10.1016/j.jcmg.2022.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/10/2022] [Accepted: 07/02/2022] [Indexed: 12/14/2022]
Abstract
Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care.
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Affiliation(s)
- Ricardo C Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida, USA.
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Stephan Achenbach
- Friedrich-Alexander-Universität, Department of Cardiology, Erlangen, Germany
| | - Daniel Berman
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marcio Bittencourt
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew Budoff
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Brian Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jill Jacobs
- NYU Langone Medical Center, New York, New York, USA
| | - Lynne Koweek
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - John Lesser
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | | | - Geoffrey D Rubin
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Eric Williamson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Todd C Villines
- Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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10
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Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, Budoff M, Chinnaiyan K, Choi AD, Ghoshhajra B, Jacobs J, Koweek L, Lesser J, Maroules C, Rubin GD, Rybicki FJ, Shaw LJ, Williams MC, Williamson E, White CS, Villines TC, Blankstein R. CAD-RADS™ 2.0 - 2022 Coronary Artery Disease - Reporting and Data System.: An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR) and the North America Society of Cardiovascular Imaging (NASCI). J Am Coll Radiol 2022; 19:1185-1212. [PMID: 36436841 DOI: 10.1016/j.jacr.2022.09.012] [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] [Indexed: 11/27/2022]
Abstract
Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in Cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care.
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Affiliation(s)
- Ricardo C Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, 8900 N Kendall Drive, Miami FL, 33176, USA.
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Stephan Achenbach
- Friedrich-Alexander-Universität, Department of Cardiology, Erlangen, Germany
| | | | | | - Matthew Budoff
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Brian Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jill Jacobs
- NYU Langone Medical Center, New York, NY, USA
| | - Lynne Koweek
- Department of Radiology, Duke University, Durham, NC, USA
| | - John Lesser
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | | | - Geoffrey D Rubin
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Todd C Villines
- Division of Cardiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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11
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Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, Budoff M, Chinnaiyan K, Choi AD, Ghoshhajra B, Jacobs J, Koweek L, Lesser J, Maroules C, Rubin GD, Rybicki FJ, Shaw LJ, Williams MC, Williamson E, White CS, Villines TC, Blankstein R. CAD-RADS™ 2.0 - 2022 Coronary Artery Disease-Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr 2022; 16:536-557. [PMID: 35864070 DOI: 10.1016/j.jcct.2022.07.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/10/2022] [Accepted: 07/02/2022] [Indexed: 12/14/2022]
Abstract
Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in Cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care.
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Affiliation(s)
- Ricardo C Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami FL, USA.
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Stephan Achenbach
- Friedrich-Alexander-Universität, Department of Cardiology, Erlangen, Germany
| | | | | | - Matthew Budoff
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Andrew D Choi
- The George Washington University School of Medicine, Washington, DC, USA
| | - Brian Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jill Jacobs
- NYU Langone Medical Center, New York, NY, USA
| | - Lynne Koweek
- Department of Radiology, Duke University, Durham, NC, USA
| | - John Lesser
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | | | - Geoffrey D Rubin
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leslee J Shaw
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Todd C Villines
- Division of Cardiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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12
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Cury RC, Leipsic J, Abbara S, Achenbach S, Berman D, Bittencourt M, Budoff M, Chinnaiyan K, Choi AD, Ghoshhajra B, Jacobs J, Koweek L, Lesser J, Maroules C, Rubin GD, Rybicki FJ, Shaw LJ, Williams MC, Williamson E, White CS, Villines TC, Blankstein R. CAD-RADS™ 2.0 - 2022 Coronary Artery Disease - Reporting and Data System An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR) and the North America Society of Cardiovascular Imaging (NASCI). Radiol Cardiothorac Imaging 2022; 4:e220183. [PMID: 36339062 PMCID: PMC9627235 DOI: 10.1148/ryct.220183] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/10/2022] [Accepted: 07/02/2022] [Indexed: 06/16/2023]
Abstract
Coronary Artery Disease Reporting and Data System (CAD-RADS) was created to standardize reporting system for patients undergoing coronary CT angiography (CCTA) and to guide possible next steps in patient management. The goal of this updated 2022 CAD-RADS 2.0 is to improve the initial reporting system for CCTA by considering new technical developments in Cardiac CT, including data from recent clinical trials and new clinical guidelines. The updated CAD-RADS classification will follow an established framework of stenosis, plaque burden, and modifiers, which will include assessment of lesion-specific ischemia using CT fractional-flow-reserve (CT-FFR) or myocardial CT perfusion (CTP), when performed. Similar to the method used in the original CAD-RADS version, the determinant for stenosis severity classification will be the most severe coronary artery luminal stenosis on a per-patient basis, ranging from CAD-RADS 0 (zero) for absence of any plaque or stenosis to CAD-RADS 5 indicating the presence of at least one totally occluded coronary artery. Given the increasing data supporting the prognostic relevance of coronary plaque burden, this document will provide various methods to estimate and report total plaque burden. The addition of P1 to P4 descriptors are used to denote increasing categories of plaque burden. The main goal of CAD-RADS, which should always be interpreted together with the impression found in the report, remains to facilitate communication of test results with referring physicians along with suggestions for subsequent patient management. In addition, CAD-RADS will continue to provide a framework of standardization that may benefit education, research, peer-review, artificial intelligence development, clinical trial design, population health and quality assurance with the ultimate goal of improving patient care. Keywords: Coronary Artery Disease, Coronary CTA, CAD-RADS, Reporting and Data System, Stenosis Severity, Report Standardization Terminology, Plaque Burden, Ischemia Supplemental material is available for this article. This article is published synchronously in Radiology: Cardiothoracic Imaging, Journal of Cardiovascular Computed Tomography, JACC: Cardiovascular Imaging, Journal of the American College of Radiology, and International Journal for Cardiovascular Imaging. © 2022 Society of Cardiovascular Computed Tomography. Published by RSNA with permission.
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Affiliation(s)
- Ricardo C. Cury
- Miami Cardiac and Vascular Institute and Baptist Health of South
Florida, 8900 N Kendall Drive, Miami FL, 33176, USA
| | | | - Suhny Abbara
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX,
USA
| | - Stephan Achenbach
- Friedrich-Alexander-Universität, Department of Cardiology,
Ulmenweg 18, 90154, Erlangen, Germany
| | | | | | | | | | - Andrew D. Choi
- The George Washington University School of Medicine, USA
| | | | - Jill Jacobs
- NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016,
USA
| | | | - John Lesser
- Division of Cardiology, Minneapolis Heart Institute, USA
| | | | | | - Frank J. Rybicki
- Department of Radiology, University of Cincinnati College of
Medicine, USA
| | | | | | | | | | - Todd C. Villines
- Division of Cardiology, University of Virginia Health System,
USA
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard Medical School,
USA
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13
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Hashimoto G, Enriquez-Sarano M, Stanberry LI, Oh F, Wang M, Acosta K, Sato H, Lopes BBC, Fukui M, Garcia S, Goessl M, Sorajja P, Bapat VN, Lesser J, Cavalcante JL. Association of Left Ventricular Remodeling Assessment by Cardiac Magnetic Resonance With Outcomes in Patients With Chronic Aortic Regurgitation. JAMA Cardiol 2022; 7:924-933. [PMID: 35857306 DOI: 10.1001/jamacardio.2022.2108] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Importance Chronic aortic regurgitation (AR) causes left ventricular (LV) volume overload, which results in progressive LV remodeling negatively affecting outcomes. Whether cardiac magnetic resonance (CMR) volumetric quantification can provide incremental risk stratification over standard clinical and echocardiographic evaluation in patients with chronic moderate or severe AR is unknown. Objective To compare LV remodeling measurements by CMR and echocardiography between patients with and without heart failure symptoms and to verify the association of remodeling measurements of patients with chronic moderate or severe AR but no or minimal symptoms with clinical outcomes receiving medical management. Design, Setting, and Participants This multicenter retrospective cohort study included consecutive patients with at least moderate chronic native AR evaluated by 2-dimensional transthoracic echocardiography and CMR examination within 90 days from each other between January 2012 and February 2020 at Allina Health System. Data were analyzed from June 2021 to January 2022. Exposures Clinical evaluation and risk stratification by CMR. Main Outcomes and Measures The end point was a composite of death, heart failure hospitalization, or progression of New York Heart Association functional class while receiving medical management, censoring patients at the time of aortic valve replacement (when performed) or at the end of follow-up. Results Of the 178 included patients, 119 (66.9%) were male, 158 (88.8%) presented with no or minimal symptoms (New York Heart Association class I or II), and the median (IQR) age was 58 (44-69) years. Compared with patients with no or minimal symptoms, symptomatic patients had greater LV end-systolic volume index (LVESVi) by CMR (median [IQR], 66 [46-85] mL/m2 vs 42 [30-58] mL/m2; P < .001), while there were no significant differences by echocardiography (LVESVi: median [IQR], 38 [30-58] mL/m2 vs 27 [20-42] mL/m2; P = .07; LV end-systolic diameter index: median [IQR], 21 [17-25] mm/m2 vs 18 [15-22] mm/m2; P = .17). During the median (IQR) follow-up of 3.3 (1.6-5.8) years, 50 patients with no or minimal symptoms receiving medical management developed the composite end point, which, in multivariate analysis adjusted for age and EuroSCORE II, was independently associated with LVESVi of 45 mL/m2 or greater and aortic regurgitant fraction of 32% or greater, the latter adding incremental prognostic value to CMR volumetric assessment. Conclusions and Relevance In patients with chronic moderate or severe AR, patients presenting with heart failure symptoms have greater LVESVi by CMR than those with no or minimal symptoms. In patients with no or minimal symptoms, CMR quantification of LVESVi and AR severity may identify those at risk of death or incident heart failure and therefore should be considered in the clinical evaluation and decision-making of these patients.
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Affiliation(s)
- Go Hashimoto
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Larissa I Stanberry
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Felix Oh
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Matthew Wang
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Keith Acosta
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Hirotomo Sato
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mario Goessl
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - John Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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14
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Fukui M, Enriquez-Sarano M, Koike H, Aluru J, Lesser A, Bapat V, Lesser J, Sorajja P, Cavalcante J. 441 Volumetric Right Ventricle Assessment Post Transcatheter Aortic Valve Replacement:findings In Routine Clinical Practice And Implications For Outcome. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Hashimoto G, Koike H, Sato H, Fukui M, Garcia S, Goessl M, Sorajja P, Bapat V, Lesser J, Sarano ME, Cavalcante J. Right Ventricular Dysfunction in Functional Mitral Regurgitation Assessed by CT. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Hammadah M, Karam J, Han BK, Bapat V, Cavalcante JL, Lesser J, Garcia S. Pulmonary Artery Pseudoaneurysm After Transcatheter Pulmonary Valve Replacement, a Novel Approach for Complication Management. Struct Heart 2022; 6:100015. [PMID: 37273746 PMCID: PMC10236866 DOI: 10.1016/j.shj.2022.100015] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/03/2021] [Accepted: 02/02/2022] [Indexed: 06/06/2023]
Affiliation(s)
- Muhammad Hammadah
- Cardiology Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Joseph Karam
- Vascular Surgery Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - B. Kelly Han
- Cardiology Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Vinayak Bapat
- Cardiothoracic Surgery Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Joao L. Cavalcante
- Cardiology Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - John Lesser
- Cardiology Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Santiago Garcia
- Cardiology Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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17
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Hashimoto G, Lopes BB, Sato H, Fukui M, Garcia S, Gössl M, Enriquez-Sarano M, Sorajja P, Bapat VN, Lesser J, Cavalcante JL. Computed Tomography Planning for Transcatheter Mitral Valve Replacement. Struct Heart 2022; 6:100012. [PMID: 37273483 PMCID: PMC10236884 DOI: 10.1016/j.shj.2022.100012] [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: 03/11/2021] [Revised: 09/02/2021] [Accepted: 11/03/2021] [Indexed: 06/06/2023]
Abstract
Transcatheter mitral valve replacement (TMVR) is a rapidly evolving treatment for mitral regurgitation. As with transcatheter aortic valve replacement, multidetector computed tomography analysis plays a central role in defining the candidacy, device selection and safety for TMVR procedures. This contemporary review will describe in detail the multidetector computed tomography data collection, analysis, and planning for TMVR procedures in patients with native mitral regurgitation as well as in those with failed surgical prosthetic mitral valve replacement or surgical mitral valve repair.
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Affiliation(s)
- Go Hashimoto
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bernardo B.C. Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hirotomo Sato
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak N. Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - John Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, 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, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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18
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Nikolakopoulos I, Lopes BBC, Vemmou E, Karacsonyi J, Cavalcante J, Lesser J, Brilakis ES. Anomalous interarterial right coronary artery culprit vessel in ST-segment elevation myocardial infarction. Coron Artery Dis 2022; 33:155-156. [PMID: 34411012 DOI: 10.1097/mca.0000000000001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ilias Nikolakopoulos
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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19
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Chugh Y, Cavalcante JL, Lesser J, Garcia S. Transcatheter pulmonic and tricuspid valve-in-valve implantation to treat sequential stenotic lesions in a septuagenarian with Tetralogy of Fallots. Cardiovascular Revascularization Medicine 2022; 43:158-159. [DOI: 10.1016/j.carrev.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
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20
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Garcia S, Fukui M, Dworak MW, Okeson BK, Garberich R, Hashimoto G, Sato H, Cavalcante JL, Bapat VN, Lesser J, Cheng V, Newell MC, Goessl M, Elmariah S, Bradley SM, Sorajja P. Clinical Impact of Hypoattenuating Leaflet Thickening After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2022; 15:e011480. [PMID: 35236097 DOI: 10.1161/circinterventions.121.011480] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hypoattenuated leaflet thickening (HALT), identified on functional cardiac computed tomography (CTA), can affect valve function and clinical outcomes. The objective of this study was to assess the impact of HALT on clinical outcomes in patients treated with transcatheter aortic valve replacement (TAVR). METHODS In July 2015, Minneapolis Heart Institute implemented prospective screening of HALT at 30-day post-TAVR with CTA. Patients with evidence of HALT were recommended to initiate anticoagulation for 3 to 6 months with warfarin. Echocardiographic, ischemic, and bleeding outcomes were compared between HALT+ and HALT- patients. Survival rates were compared between HALT+ and HALT- patients using log-rank test, with Cox regression analysis used to identify variables independently associated with long-term death landmarked at time of CTA. This analysis included patients treated from July 1, 2015 to October 31, 2019. RESULTS Of 856 patients undergoing TAVR during the study period, 638 (75%) underwent CTA post-TAVR (median time 31 [30-37] days). HALT+ was evident in 79 (12.3%). HALT+ patients were more likely prescribed warfarin at 1, 3, and 12 months (all P<0.001) and had similar gradients compared with HALT- patients. After a median follow-up of 2.2 years (1.5-3.2), HALT+ patients had increased mortality (30% versus 20%; P=0.001). In Cox regression analysis, presence of HALT (hazard ratio, 1.83 [95% CI, 1.13-2.97]; P=0.014) remained independently associated with long-term mortality. CONCLUSIONS In a large, real-world cohort of patients receiving TAVR followed by systematic screening with CTA 30-days post-procedure, HALT was found in 12% of patients and independently associated with long-term mortality. Findings of this nonrandomized, observational cohort study require independent validation.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Miho Fukui
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Marshall W Dworak
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Brynn K Okeson
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Ross Garberich
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Go Hashimoto
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Hirotomo Sato
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Vinayak N Bapat
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - John Lesser
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Victor Cheng
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Marc C Newell
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Mario Goessl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Sammy Elmariah
- Massachusetts General Hospital and Harvard Medical School, Boston (S.E.)
| | - Steven M Bradley
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
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21
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Crean A, Benson L, Shah A, Han K, Lesser J, McCrindle BW. Imaging the delayed complications of childhood Kawasaki disease. F1000Res 2022; 11:147. [PMID: 36970577 PMCID: PMC10036956 DOI: 10.12688/f1000research.73097.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
This review will discuss the long-term complications of Kawasaki disease with a particular focus on imaging surveillance of the coronary arteries in adolescence and adult life. The relative advantages and disadvantages of each modality will be illustrated with practical examples, demonstrating that, in many cases, a multimodality imaging strategy may be required.
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Affiliation(s)
- Andrew Crean
- Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada
| | - Lee Benson
- Cardiology, Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Ashish Shah
- Cardiology, St Boniface Hospital, Winnipeg, Manitoba, R2H 2A6, Canada
| | - Kelly Han
- Cardiology, Children's Minnesota Hospital, Minneapolis, MN, 55404, USA
| | - John Lesser
- Cardiology, Minneapolis Heart Institute, Minneapolis, MN, 55407, USA
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22
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Hashimoto G, Sarano M, Sato H, Lopes B, Fukui M, Stanberry L, Cheng V, Garcia S, Goessl M, Sorajja P, Bapat V, Lesser J, Cavalcante J. The left ventricular remodeling assessment by cardiac magnetic resonance in chronic aortic regurgitation; implications for outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Chronic aortic regurgitation (AR) causes left ventricular (LV) volume overload resulting in progressive LV remodeling, which negatively affect clinical outcome. Clinical Guidelines recommend assessment of LV remodeling by echocardiography, but little is known about comparative remodeling quantification by cardiac magnetic resonance (CMR) and association with outcomes.
Purpose
To assess LV remodeling in AR by CMR, compared with echocardiographic measures and determine its impact on clinical outcome.
Methods
Patients with native, ≥moderate, chronic AR by echocardiography who underwent CMR exam within 90 days of diagnosis from January 2012 to February 2020 were enrolled. The endpoint was a composite of death, heart failure hospitalization, and heart failure symptom exacerbation during follow-up.
Results
The 178 patients included had median age (IQR) of 58 years (44–69), and most (88%, n=158) presented with no or minimal symptoms (NYHA class I/II). At diagnosis symptomatic vs. no/minimal symptoms patients presented with much more advanced LV remodeling by CMR (EDVI 133 [83–151] vs. 96 [80–123] p=0.024, ESVI 66 [46–85] vs. 42 [30–58], P=0.001) while echocardiography showed limited differences (EDVI 76 [57–93] vs. 65 [54–87] p=0.507, ESVI 38 [30–58] vs. 27 [20–42], p=0.072). During follow-up (3.3 years [1.6–5.8]), aortic valve replacement (AVR) was performed in 49 patients. In patients with no/minimal symptoms, the composite endpoint occurred in 54 (34%) patients including eight deaths and 30 heart failure hospitalizations. Patients with LV end-systolic volume index (LVESVi) >45 ml/m2 by CMR had higher likelihood for composite endpoint (Panel A) confirmed in multivariate models, adjusting for age, sex, AVR (time-dependent), EuroSCORE2, and LV End-systolic-dimension-index (LVESDi) >25 mm/2, with adjusted hazard ratio 1.84 [1.02–3.33], p<0.044 (Panel B). LVESVi by CMR was at least as powerful in determining clinical outcomes as guideline-recommended Doppler-Echocardiographic variables.
Conclusion
Assessment of LV remodeling by CMR in patients with clinically significant AR is feasible in routine clinical practice, detects with high sensitivity LV remodeling associated with development of HF symptoms and is independently predictive of clinical outcome. Hence, CMR provides a powerful tool for evaluation and risk stratification of patients with AR.
Funding Acknowledgement
Type of funding sources: None. Panel APanel B
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Affiliation(s)
- G Hashimoto
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Sarano
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - H Sato
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - B Lopes
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - L Stanberry
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - V Cheng
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - S Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Goessl
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - P Sorajja
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - V Bapat
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Lesser
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
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Kudo T, Lahey R, Hirschfeld CB, Williams MC, Lu B, Alasnag M, Bhatia M, Henry Bom HS, Dautov T, Fazel R, Karthikeyan G, Keng FY, Rubinshtein R, Better N, Cerci RJ, Dorbala S, Raggi P, Shaw LJ, Villines TC, Vitola JV, Choi AD, Malkovskiy E, Goebel B, Cohen YA, Randazzo M, Pascual TN, Pynda Y, Dondi M, Paez D, Einstein AJ, Einstein AJ, Paez D, Dondi M, Better N, Cerci R, Dorbala S, Pascual TN, Raggi P, Shaw LJ, Villines TC, Vitola JV, Williams MC, Pynda Y, Hinterleitner G, Lu Y, Morozova O, Xu Z, Hirschfeld CB, Cohen Y, Goebel B, Malkovskiy E, Randazzo M, Choi A, Lopez-Mattei J, Parwani P, Nasery MN, Goda A, Shirka E, Benlabgaa R, Bouyoucef S, Medjahedi A, Nailli Q, Agolti M, Aguero RN, Alak MDC, Alberguina LG, Arroñada G, Astesiano A, Astesiano A, Norton CB, Benteo P, Blanco J, Bonelli JM, Bustos JJ, Cabrejas R, Cachero J, Campisi R, Canderoli A, Carames S, Carrascosa P, Castro R, Cendoya O, Cognigni LM, Collaud C, Collaud C, Cortes C, Courtis J, Cragnolino D, Daicz M, De La Vega A, De Maria ST, Del Riego H, Dettori F, Deviggiano A, Dragonetti L, Embon M, Enriquez RE, Ensinas J, Faccio F, Facello A, Topping W, Tweed K, Weir-Mccall J, Abbara S, Abbasi T, Abbott B, Abohashem S, Abramson S, Al-Abboud T, Al-Mallah M, Garofalo D, Almousalli O, Ananthasubramaniam K, Kumar MA, Askew J, Attanasio L, Balmer-Swain M, Bayer RR, Bernheim A, Bhatti S, Bieging E, Geronazzo R, Blankstein R, Bloom S, Blue S, Bluemke D, Borges A, Branch K, Bravo P, Brothers J, Budoff M, Bullock-Palmer R, Gonza N, Burandt A, Burke FW, Bush K, Candela C, Capasso E, Cavalcante J, Chang D, Chatterjee S, Chatzizisis Y, Cheezum M, Gutierrez L, Chen T, Chen J, Chen M, Choi A, Clarcq J, Cordero A, Crim M, Danciu S, Decter B, Dhruva N, Guzzo MA, Doherty N, Doukky R, Dunbar A, Duvall W, Edwards R, Esquitin K, Farah H, Fentanes E, Ferencik M, Fisher D, Guzzo MA, Fitzpatrick D, Foster C, Fuisz T, Gannon M, Gastner L, Gerson M, Ghoshhajra B, Goldberg A, Goldner B, Gonzalez J, Hasbani V, Gore R, Gracia-López S, Hage F, Haider A, Haider S, Hamirani Y, Hassen K, Hatfield M, Hawkins C, Hawthorne K, Huerin M, Heath N, Hendel R, Hernandez P, Hill G, Horgan S, Huffman J, Hurwitz L, Iskandrian A, Janardhanan R, Jellis C, Jäger V, Jerome S, Kalra D, Kaviratne S, Kay F, Kelly F, Khalique O, Kinkhabwala M, Iii GK, Kircher J, Kirkbride R, Lewkowicz JM, Kontos M, Kottam A, Krepp J, Layer J, Lee SH, Leppo J, Lesser J, Leung S, Lewin H, Litmanovich D, López De Munaín MNA, Liu Y, Lopez-Mattei J, Magurany K, Markowitz J, Marn A, Matis SE, Mckenna M, Mcrae T, Mendoza F, Merhige M, Lotti JM, Min D, Moffitt C, Moncher K, Moore W, Morayati S, Morris M, Mossa-Basha M, Mrsic Z, Murthy V, Nagpal P, Marquez A, Napier K, Nelson K, Nijjar P, Osman M, Parwani P, Passen E, Patel A, Patil P, Paul R, Phillips L, Masoli O, Polsani V, Poludasu R, Pomerantz B, Porter T, Prentice R, Pursnani A, Rabbat M, Ramamurti S, Rich F, Luna HR, Masoli OH, Robinson A, Robles K, Rodríguez C, Rorie M, Rumberger J, Russell R, Sabra P, Sadler D, Schemmer M, Schoepf UJ, Mastrovito E, Shah S, Shah N, Shanbhag S, Sharma G, Shayani S, Shirani J, Shivaram P, Sigman S, Simon M, Slim A, Mayoraz M, Smith D, Smith A, Soman P, Sood A, Srichai-Parsia MB, Streeter J, T A, Tawakol A, Thomas D, Thompson R, Melado GE, Torbet T, Trinidad D, Ullery S, Unzek S, Uretsky S, Vallurupalli S, Verma V, Waller A, Wang E, Ward P, Mele A, Weissman G, Wesbey G, White K, Winchester D, Wolinsky D, Yost S, Zgaljardic M, Alonso O, Beretta M, Ferrando R, Merani MF, Kapitan M, Mut F, Djuraev O, Rozikhodjaeva G, Le Ngoc H, Mai SH, Nguyen XC, Meretta AH, Molteni S, Montecinos M, Noguera E, Novoa C, Sueldo CP, Ascani SP, Pollono P, Pujol MP, Radzinschi A, Raimondi G, Redruello M, Rodríguez M, Rodríguez M, Romero RL, Acuña AR, Rovaletti F, San Miguel L, Solari L, Strada B, Traverso S, Traverzo SS, Espeche MDHV, Weihmuller JS, Wolcan J, Zeffiro S, Sakanyan M, Beuzeville S, Boktor R, Butler P, Calcott J, Carr L, Chan V, Chao C, Chong W, Dobson M, Downie D, Dwivedi G, Elison B, Engela J, Francis R, Gaikwad A, Basavaraj AG, Goodwin B, Greenough R, Hamilton-Craig C, Hsieh V, Joshi S, Lederer K, Lee K, Lee J, Magnussen J, Mai N, Mander G, Murton F, Nandurkar D, Neill J, O'Rourke E, O'Sullivan P, Pandos G, Pathmaraj K, Pitman A, Poulter R, Premaratne M, Prior D, Ridley L, Rutherford N, Salehi H, Saunders C, Scarlett L, Seneviratne S, Shetty D, Shrestha G, Shulman J, Solanki V, Stanton T, Stuart M, Stubbs M, Swainson I, Taubman K, Taylor A, Thomas P, Unger S, Upton A, Vamadevan S, Van Gaal W, Verjans J, Voutnis D, Wayne V, Wilson P, Wong D, Wong K, Younger J, Feuchtner G, Mirzaei S, Weiss K, Maroz-Vadalazhskaya N, Gheysens O, Homans F, Moreno-Reyes R, Pasquet A, Roelants V, Van De Heyning CM, Ríos RA, Soldat-Stankovic V, Stankovic S, Albernaz Siqueira MH, Almeida A, Alves Togni PH, Andrade JH, Andrade L, Anselmi C, Araújo R, Azevedo G, Bezerra S, Biancardi R, Grossman GB, Brandão S, Pianta DB, Carreira L, Castro B, Chang T, Cunali F, Cury R, Dantas R, de Amorim Fernandes F, De Lorenzo A, De Macedo Filho R, Erthal F, Fernandes F, Fernandes J, Fernandes F, De Souza TF, Alves WF, Ghini B, Goncalves L, Gottlieb I, Hadlich M, Kameoka V, Lima R, Lima A, Lopes RW, Machado e Silva R, Magalhães T, Silva FM, Mastrocola LE, Medeiros F, Meneghetti JC, Naue V, Naves D, Nolasco R, Nomura C, Oliveira JB, Paixao E, De Carvalho FP, Pinto I, Possetti P, Quinta M, Nogueira Ramos RR, Rocha R, Rodrigues A, Rodrigues C, Romantini L, Sanches A, Santana S, Sara da Silva L, Schvartzman P, Matushita CS, Senra T, Shiozaki A, Menezes de Siqueira ME, Siqueira C, Smanio P, Soares CE, Junior JS, Bittencourt MS, Spiro B, Mesquita CT, Torreao J, Torres R, Uellendahl M, Monte GU, Veríssimo O, Cabeda EV, Pedras FV, Waltrick R, Zapparoli M, Naseer H, Garcheva-Tsacheva M, Kostadinova I, Theng Y, Abikhzer G, Barette R, Chow B, Dabreo D, Friedrich M, Garg R, Hafez MN, Johnson C, Kiess M, Leipsic J, Leung E, Miller R, Oikonomou A, Probst S, Roifman I, Small G, Tandon V, Trivedi A, White J, Zukotynski K, Canessa J, Muñoz GC, Concha C, Hidalgo P, Lovera C, Massardo T, Vargas LS, Abad P, Arturo H, Ayala S, Benitez L, Cadena A, Caicedo C, Moncayo AC, Moncayo AC, Gomez S, Gutierrez Villamil CT, Jaimes C, Londoño J, Londoño Blair JL, Pabon L, Pineda M, Rojas JC, Ruiz D, Escobar MV, Vasquez A, Vergel D, Zuluaga A, Gamboa IB, Castro G, González U, Baric A, Batinic T, Franceschi M, Paar MH, Jukic M, Medakovic P, Persic V, Prpic M, Punda A, Batista JF, Gómez Lauchy JM, Gutierrez YM, Gutierrez YM, Menéndez R, Peix A, Rochela L, Panagidis C, Petrou I, Engelmann V, Kaminek M, Kincl V, Lang O, Simanek M, Abdulla J, Bøttcher M, Christensen M, Gormsen LC, Hasbak P, Hess S, Holdgaard P, Johansen A, Kyhl K, Norgaard BL, Øvrehus KA, Rønnow Sand NP, Steffensen R, Thomassen A, Zerahn B, Perez A, Escorza Velez GA, Velez MS, Abdel Aziz IS, Abougabal M, Ahmed T, Allam A, Asfour A, Hassan M, Hassan A, Ibrahim A, Kaffas S, Kandeel A, Ali MM, Mansy A, Maurice H, Nabil S, Shaaban M, Flores AC, Poksi A, Knuuti J, Kokkonen V, Larikka M, Uusitalo V, Bailly M, Burg S, Deux JF, Habouzit V, Hyafil F, Lairez O, Proffit F, Regaieg H, Sarda-Mantel L, Tacher V, Schneider RP, Ayetey H, Angelidis G, Archontaki A, Chatziioannou S, Datseris I, Fragkaki C, Georgoulias P, Koukouraki S, Koutelou M, Kyrozi E, Repasos E, Stavrou P, Valsamaki P, Gonzalez C, Gutierrez G, Maldonado A, Buga K, Garai I, Maurovich-Horvat P, Schmidt E, Szilveszter B, Várady E, Banthia N, Bhagat JK, Bhargava R, Bhat V, Bhatia M, Choudhury P, Chowdekar VS, Irodi A, Jain S, Joseph E, Kumar S, Girijanandan Mahapatra PD, Mitra D, Mittal BR, Ozair A, Patel C, Patel T, Patel R, Patel S, Saxena S, Sengupta S, Singh S, Singh B, Sood A, Verma A, Affandi E, Alam PS, Edison E, Gunawan G, Hapkido H, Hidayat B, Huda A, Mukti AP, Prawiro D, Soeriadi EA, Syawaluddin H, Albadr A, Assadi M, Emami F, Houshmand G, Maleki M, Rostami MT, Zakavi SR, Zaid EA, Agranovich S, Arnson Y, Bar-Shalom R, Frenkel A, Knafo G, Lugassi R, Maor Moalem IS, Mor M, Muskal N, Ranser S, Shalev A, Albano D, Alongi P, Arnone G, Bagatin E, Baldari S, Bauckneht M, Bertelli P, Bianco F, Bonfiglioli R, Boni R, Bruno A, Bruno I, Busnardo E, Califaretti E, Camoni L, Carnevale A, Casoni R, Cavallo AU, Cavenaghi G, Chierichetti F, Chiocchi M, Cittanti C, Colletta M, Conti U, Cossu A, Cuocolo A, Cuzzocrea M, De Rimini ML, De Vincentis G, Del Giudice E, Del Torto A, Della Tommasina V, Durmo R, Erba PA, Evangelista L, Faletti R, Faragasso E, Farsad M, Ferro P, Florimonte L, Frantellizzi V, Fringuelli FM, Gatti M, Gaudiano A, Gimelli A, Giubbini R, Giuffrida F, Ialuna S, Laudicella R, Leccisotti L, Leva L, Liga R, Liguori C, Longo G, Maffione M, Mancini ME, Marcassa C, Milan E, Nardi B, Pacella S, Pepe G, Pontone G, Pulizzi S, Quartuccio N, Rampin L, Ricci F, Rossini P, Rubini G, Russo V, Sacchetti GM, Sambuceti G, Scarano M, Sciagrà R, Sperandio M, Stefanelli A, Ventroni G, Zoboli S, Baugh D, Chambers D, Madu E, Nunura F, Asano H, Chimura CM, Fujimoto S, Fujisue K, Fukunaga T, Fukushima Y, Fukuyama K, Hashimoto J, Ichikawa Y, Iguchi N, Imai M, Inaki A, Ishimura H, Isobe S, Kadokami T, Kato T, Kudo T, Kumita S, Maruno H, Mataki H, Miyagawa M, Morimoto R, Moroi M, Nagamachi S, Nakajima K, Nakata T, Nakazato R, Nanasato M, Naya M, Norikane T, Ohta Y, Okayama S, Okizaki A, Otomi Y, Otsuka H, Saito M, Sakata SY, Sarai M, Sato D, Shiraishi S, Suwa Y, Takanami K, Takehana K, Taki J, Tamaki N, Taniguchi Y, Teragawa H, Tomizawa N, Tsujita K, Umeji K, Wakabayashi Y, Yamada S, Yamazaki S, Yoneyama T, Rawashdeh M, Batyrkhanov D, Dautov T, Makhdomi K, Ombati K, Alkandari F, Garashi M, Coie TL, Rajvong S, Kalinin A, Kalnina M, Haidar M, Komiagiene R, Kviecinskiene G, Mataciunas M, Vajauskas D, Picard C, Karim NKA, Reichmuth L, Samuel A, Allarakha MA, Naojee AS, Alexanderson-Rosas E, Barragan E, González-Montecinos AB, Cabada M, Rodriguez DC, Carvajal-Juarez I, Cortés V, Cortés F, De La Peña E, Gama-Moreno M, González L, Ramírez NG, Jiménez-Santos M, Matos L, Monroy E, Morelos M, Ornelas M, Ortga Ramirez JA, Preciado-Anaya A, Preciado-Gutiérrez ÓU, Barragan AP, Rosales Uvera SG, Sandoval S, Tomas MS, Sierra-Galan LM, Sierra-Galan LM, Siu S, Vallejo E, Valles M, Faraggi M, Sereegotov E, Ilic S, Ben-Rais N, Alaoui NI, Taleb S, Pa Myo KP, Thu PS, Ghimire RK, Rajbanshi B, Barneveld P, Glaudemans A, Habets J, Koopmans KP, Manders J, Pool S, Scholte A, Scholtens A, Slart R, Thimister P, Van Asperen EJ, Veltman N, Verschure D, Wagenaar N, Edmond J, Ellis C, Johnson K, Keenan R, Kueh SH(A, Occleshaw C, Sasse A, To A, Van Pelt N, Young C, Cuadra T, Roque Vanegas HB, Soli IA, Issoufou DM, Ayodele T, Madu C, Onimode Y, Efros-Monsen E, Forsdahl SH, Hildre Dimmen JM, Jørgensen A, Krohn I, Løvhaugen P, Bråten AT, Al Dhuhli H, Al Kindi F, Al-Bulushi N, Jawa Z, Tag N, Afzal MS, Fatima S, Younis MN, Riaz M, Saadullah M, Herrera Y, Lenturut-Katal D, Vázquez MC, Ortellado J, Akhter A, Cao D, Cheung S, Dai X, Gong L, Han D, Hou Y, Li C, Li T, Li D, Li S, Liu J, Liu H, Lu B, Ng MY, Sun K, Tang G, Wang J, Wang X, Wang ZQ, Wang Y, Wang Y, Wu J, Wu Z, Xia L, Xiao J, Xu L, Yang Y, Yin W, Yu J, Yuan L, Zhang T, Zhang L, Zhang YG, Zhang X, Zhu L, Alfaro A, Abrihan P, Barroso A, Cruz E, Gomez MR, Magboo VP, Medina JM, Obaldo J, Pastrana D, Pawhay CM, Quinon A, Tang JM, Tecson B, Uson KJ, Uy M, Kostkiewicz M, Kunikowska J, Bettencourt N, Cantinho G, Ferreira A, Syed G, Arnous S, Atyani S, Byrne A, Gleeson T, Kerins D, Meehan C, Murphy D, Murphy M, Murray J, O'Brien J, Bang JI, Bom H, Cho SG, Hong CM, Jang SJ, Jeong YH, Kang WJ, Kim JY, Lee J, Namgung CK, So Y, Won KS, Majstorov V, Vavlukis M, Salobir BG, Štalc M, Benedek T, Benedek I, Mititelu R, Stan CA, Ansheles A, Dariy O, Drozdova O, Gagarina N, Gulyaev VM, Itskovich I, Karalkin A, Kokov A, Migunova E, Pospelov V, Ryzhkova D, Saifullina G, Sazonova S, Sergienko V, Shurupova I, Trifonova T, Ussov WY, Vakhromeeva M, Valiullina N, Zavadovsky K, Zhuravlev K, Alasnag M, Okarvi S, Saranovic DS, Keng F, Jason See JH, Sekar R, Yew MS, Vondrak A, Bejai S, Bennie G, Bester R, Engelbrecht G, Evbuomwan O, Gongxeka H, Vuuren MJ, Kaplan M, Khushica P, Lakhi H, Louw L, Malan N, Milos K, Modiselle M, More S, Naidoo M, Scholtz L, Vangu M, Aguadé-Bruix S, Blanco I, Cabrera A, Camarero A, Casáns-Tormo I, Cuellar-Calabria H, Flotats A, Fuentes Cañamero ME, García ME, Jimenez-Heffernan A, Leta R, Diaz JL, Lumbreras L, Marquez-Cabeza JJ, Martin F, Martinez de Alegria A, Medina F, Canal MP, Peiro V, Pubul-Nuñez V, Rayo Madrid JI, Rey CR, Perez RR, Ruiz J, Hernández GS, Sevilla A, Zeidán N, Nanayakkara D, Udugama C, Simonsson M, Alkadhi H, Buechel RR, Burger P, Ceriani L, De Boeck B, Gräni C, Juillet de Saint Lager Lucas A, Kamani CH, Kawel-Boehm N, Manka R, Prior JO, Rominger A, Vallée JP, Khiewvan B, Premprabha T, Thientunyakit T, Sellem A, Kir KM, Sayman H, Sebikali MJ, Muyinda Z, Kmetyuk Y, Korol P, Mykhalchenko O, Pliatsek V, Satyr M, Albalooshi B, Ahmed Hassan MI, Anderson J, Bedi P, Biggans T, Bularga A, Bull R, Burgul R, Carpenter JP, Coles D, Cusack D, Deshpande A, Dougan J, Fairbairn T, Farrugia A, Gopalan D, Gummow A, Ramkumar PG, Hamilton M, Harbinson M, Hartley T, Hudson B, Joshi N, Kay M, Kelion A, Khokhar A, Kitt J, Lee K, Low C, Mak SM, Marousa N, Martin J, Mcalindon E, Menezes L, Morgan-Hughes G, Moss A, Murray A, Nicol E, Patel D, Peebles C, Pugliese F, Luis Rodrigues JC, Rofe C, Sabharwal N, Schofield R, Semple T, Sharma N, Strouhal P, Subedi D. Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia. JACC: Asia 2021; 1:187-199. [PMID: 36338167 PMCID: PMC9627847 DOI: 10.1016/j.jacasi.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/12/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Abstract
Background The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.
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Xenogiannis I, Jaffer F, Shah A, Omer M, Megaly M, Vemmou E, Nikolakopoulos I, Rangan B, Garcia S, Lesser J, Cavalcante J, Burke M, Brilakis E. Computed tomography angiography co-registration with real-time fluoroscopy in percutaneous coronary intervention for chronic total occlusions. EUROINTERVENTION 2021; 17:e433-e435. [PMID: 32657275 PMCID: PMC9724964 DOI: 10.4244/eij-d-20-00175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Iosif Xenogiannis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Farouc Jaffer
- Interventional Cardiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Alpesh Shah
- Interventional Cardiology Department, Houston Methodist Hospital, Houston, TX, USA
| | - Mohamed Omer
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Michael Megaly
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Evangelia Vemmou
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Ilias Nikolakopoulos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Bavana Rangan
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Santiago Garcia
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - John Lesser
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - João Cavalcante
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - M. Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, Minneapolis, MN, USA
| | - Emmanouil Brilakis
- Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, MN 55407, USA
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Hashimoto G, Cavalcante J, Fukui M, Lopes BB, Sato H, Schmidt C, Burns M, Gossl M, Sorajja P, Sarano ME, Lesser J, Bapat V, Garcia S. ASSESSMENT OF BIOPROSTHETIC VALVE REMODELING WITH FRACTURE PROCEDURE IN VALVE-IN-VALVE TAVR BY COMPUTED TOMOGRAPHY ANGIOGRAPHY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02672-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fukui M, Hashimoto G, Lopes B, Du Y, Stanberry L, Garcia S, Goessl M, Enriquez-Sarano M, Bapat V, Sorajja P, Lesser J, Cavalcante J. Computed tomography derived left ventricular global longitudinal strain associate with clinical outcomes in patients undergoing transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Computed tomography angiography (CTA) is key imaging modality for procedure planning for transcatheter aortic valve replacement (TAVR). Functional assessment by CTA with LV global longitudinal strain (LVGLS) has recently shown to be feasible. However, there is limited data on its prognostic value in patients with severe aortic stenosis (AS) who treated with TAVR.
Purpose
To evaluate the association of baseline CTA-LVGLS with post-TAVR outcome.
Methods
Patients who underwent contrast multiphasic gated CTA for TAVR planning were studied. LVGLS was measured using dedicated feature-tracking software (Medis®). Cox regression analysis evaluated the association of baseline LVGLS with a composite outcome of all-cause death and heart failure hospitalization after TAVR.
Results
A total of 431 patients were included (median [IQR] age, 83 [77,87]years; 44% female); the society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score, 3.3 [2.3,5.1]%; CTA-LVGLS, -18.0 [-21.6,-14.2]%; LV ejection fraction was preserved at 60 [55,65]%. After a median follow-up of 19 [13,27] months, 99 composite outcomes occurred after TAVR. On multivariable Cox regression analysis, LVGLS was associated with the risk of composite outcome even after adjustment for baseline characteristics (Figure A). Patients with reduced LVGLS (above the median >-18.0%) had higher risk of the composite outcome than those with preserved GLS (p = 0.003; Figure B).
Conclusion
Baseline CTA-LVGLS was associated with the risk of death or heart failure hospitalization over the clinical and echocardiographic characteristics in severe AS patients undergoing TAVR.
Abstract Figure.
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Affiliation(s)
- M Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - G Hashimoto
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - B Lopes
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - Y Du
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - L Stanberry
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - S Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Goessl
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Enriquez-Sarano
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - V Bapat
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - P Sorajja
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Lesser
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
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Hashimoto G, Lopes B, Fukui M, Sarano M, Garcia S, Goessl M, Sorajja P, Lesser J, Cavalcante J. Computed tomography characteristics of patients with functional MR receiving MitraClip. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Percutaneous leaflet repair with the MitraClip device (Abbott Vascular, Menlo Park, CA) is safe and effective in patients with severe functional mitral regurgitation (FMR). Residual or recurrent MR may occur in up to 40% of patients and is associated with persistent symptoms and impaired survival. The anatomical characteristics associated with residual or recurrent MR after MitraClip are not well defined by computed tomography angiography (CTA) in FMR population.
Methods
A retrospective analysis of patients with significant FMR, who underwent retrospective-gated CTA at Minneapolis Heart Institute between July 2015 to January 2020, identified those who underwent percutaneous leaflet repair with MitraClip. Anatomical and functional parameters were assessed by pre-procedure CTA and compared between those with and without residual (≥2) MR.
Results
A total of 25 patients were included (median[Q1, Q3]; age, 80[75, 85]; 44% men) and classified into ventricular FMR (V-FMR, n = 12) and atrial FMR (A-FMR, n = 13) according to anatomical and functional characteristics by CTA. 50% of V-FMR and 38% of A-FMR had residual/worsening MR. Among V-FMR patients with residual/worsening MR, shorter coaptation length was observed (2.2[2, 2.3] mm vs. 3.5[3, 4], p = 0.006) (Figure). No differences in anatomical or functional characteristics were seen in A-FMR patients.
Conclusion
Longer coaptation length in V-FMR is predictive of successful MitraClip procedure, whereas mitral annulus size and cardiac volumes are not.
<Ventricular FMR> Total (N = 12) No residual/no worsening MR (N = 6) Residual/worsening MR (N = 6) P value Septal-lateral diameter, mm 31.9 (30.5, 37.9) 32.2 (30.1, 39.8) 31.9 (29.5, 35) 0.749 Annulus area, cm² 11.2 (10.4, 13.6) 11.3 (10.1, 14.6) 11.1 (9.6, 12.6) 0.631 Tenting area, cm² 1.6 (1.3, 2.1) 1.6 (1.2, 2.2) 1.7 (1.2, 2.3) 0.873 Tenting height, mm 8.5 (6.5, 9.7) 8.5 (6.6, 9.3) 8.3 (6.3, 10.1) 0.749 Coaptation length, mm 2.6 (2.1, 3.5) 3.5 (3.0, 4.0) 2.2 (2.0, 2.3) 0.006 <Atrial FMR> Total (N = 13) No residual/no worsening MR (N = 8) Residual/worsening MR (N = 5) P value Septal-lateral diameter, mm 32.3 (29.5, 39.0) 32.0 (29.2, 39.9) 34.3 (30.8, 39.02) 0.464 Annulus area, cm² 10.3 (9.2, 14.7) 10.2 (9.0, 14.6) 12.4 (9.4, 14.7) 0.661 Tenting area, cm² 1.2 (0.8, 1.8) 1.1 (0.7, 2.2) 1.3 (0.7, 1.8) 0.884 Tenting height, mm 5.5 (4.1, 6.9) 6.3 (4.1, 8.7) 4.6 (3.7, 5.8) 0.213 Coaptation length, mm 2.3 (1.5, 2.8) 2.5 (1.4, 3.5) 1.9 (1.5, 2.6) 0.464 Comparison of baseline CT parameters between no residual/ no worsening MR and residual/ worsening MR Abstract Figure.
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Affiliation(s)
- G Hashimoto
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - B Lopes
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Sarano
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - S Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Goessl
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - P Sorajja
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Lesser
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
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Hashimoto G, Lopes B, Fukui M, Sarano M, Garcia S, Goessl M, Sorajja P, Lesser J, Cavalcante-Dupe J. TCT CONNECT-331 The Baseline Characteristics of Successful MitraClip Procedure Assessed by CTA in Patients With Functional MR. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lopes B, Hashimoto G, Fukui M, Du Y, Schwartz R, Bae R, Stanberry L, Sarano M, Lesser J, Sorajja P, Cavalcante-Dupe J. TCT CONNECT-492 Tricuspid Anatomic Regurgitant Orifice Area Assessment by Functional DSCT: Reproducibility and Comparison With 3D TEE. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fukui M, Hashimoto G, Lopes B, Du Y, Garcia S, Goessl M, Sarano M, Sorajja P, Lesser J, Cavalcante J. TCT CONNECT-83 Association of Computed Tomography Derived Left Ventricular Global Longitudinal Strain With Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fukui M, Sorajja P, Gössl M, Bae R, Lesser J, Sun B, Duncan A, Muller D, Cavalcante J. Computed Tomography Assessment For Left Atrial And Ventricular Remodeling Post-transcatheter Mitral Valve Replacement. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fukui M, Tiang L, Lesser J, Niikura H, Nunes M, Burns M, Schneider L, Han K, Garcia S, Gossl M, Sorajja P, Cavalcante J. P212 Computed tomography derived left ventricular outflow tract area downgrades severity of prosthesis-patient mismatch after transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Prosthesis-patient mismatch (PPM) is associated with poor outcomes after surgical aortic valve replacement, but evidence in the era of transcatheter aortic valve replacement (TAVR) is small. Although PPM is conventionally defined by transthoracic echocardiogram (TTE) derived indexed effective orifice area (EOAi), TTE may underestimate left ventricular outflow tract (LVOT) area when compared with cardiac computed tomography angiography (CTA).
Purpose
To evaluate the inter-modality (TTE vs CTA) agreement and inter-valve (balloon-expanding valve (BEV) vs. self-expandable valve (SEV)) differences in EOAi and the severity of PPM after TAVR.
Methods
We analyzed all patients who underwent TAVR between 2015 to 2017and who had both of CTA and TTE at 30-days after TAVR. EOAi was calculated using the continuity equation and then indexed to body surface area as per guidelines using TTE derived LVOT diameter (EOAi-TTE) or post-procedure CTA derived LVOT area (EOAi-CTA). The external LVOT diameter was measured at inflow of TAVR bioprosthetic stent frame as per recommendations. The EOAi was used to define the grading severity of PPM: None (> 0.85 cm²/m²); Moderate (0.65 to 0.85 cm²/m²); and Severe (< 0.65 cm²/m²). Paired or Student t-test and Chi-square test were used to assess the inter-modality and inter-valve difference.
Results
A total of 280 patients were included (the mean age, 81.2 ± 8.1 years; 48%, female). BEV was used in 150 patients (54%). The mean EOAi-TTE vs. EOAi-CTA was 1.00 ± 0.32 and 1.41 ± 0.50 cm²/m², respectively, p < 0.001. Prevalence of severe (TTE 9% versus CTA 4%, p < 0.01) and moderate (TTE 28% versus CTA 7%, p < 0.01) PPM was lower when adjudicated by CTA (Figure-Panel A). There was a trends towards smaller EOAi by either TTE (0.97 ± 0.31 vs. 1.04 ± 0.33, p = 0.07) or CTA (1.38 ± 0.45 vs. 1.46 ± 0.56, p = 0.21) for BEV vs. SEV (Figure-Panel B). There was no significant difference in the severity of PPM defined by either EOAi-TTE (Figure-Panel C) or EOAi-CTA (Figure-Panel D) between these patients.
Conclusion
EOAi-CTA was larger and downgraded the severity of PPM than the EOAi-TTE. There was no significant difference in the severity of PPM defined by post-procedure CT between patients treated with BEV and those with SEV.
Abstract P212 Figure.
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Affiliation(s)
- M Fukui
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - L Tiang
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - J Lesser
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - H Niikura
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - M Nunes
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - M Burns
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - L Schneider
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - K Han
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - S Garcia
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - M Gossl
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - P Sorajja
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
| | - J Cavalcante
- Minneapolis Heart Institute Foundation, Valve Heart Center, Minneapolis, United States of America
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Stocker TJ, Deseive S, Leipsic J, Hadamitzky M, Chen MY, Rubinshtein R, Heckner M, Bax JJ, Fang XM, Grove EL, Lesser J, Maurovich-Horvat P, Otton J, Shin S, Pontone G, Marques H, Chow B, Nomura CH, Tabbalat R, Schmermund A, Kang JW, Naoum C, Atkins M, Martuscelli E, Massberg S, Hausleiter J. Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 (PROTECTION VI). Eur Heart J 2019; 39:3715-3723. [PMID: 30165629 DOI: 10.1093/eurheartj/ehy546] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/22/2018] [Indexed: 01/12/2023] Open
Abstract
Aims Advances of cardiac computed tomography angiography (CTA) have been developed for dose reduction, but their efficacy in clinical practice is largely unknown. This study was designed to evaluate radiation dose exposure and utilization of dose-saving strategies for contrast-enhanced cardiac CTA in daily practice. Methods and results Sixty one hospitals from 32 countries prospectively enrolled 4502 patients undergoing cardiac CTA during one calendar month in 2017. Computed tomography angiography scan data and images were analysed in a central core lab and compared with a similar dose survey performed in 2007. Linear regression analysis was performed to identify independent predictors associated with dose. The most frequent indication for cardiac CTA was the evaluation of coronary artery disease in 89% of patients. The median dose-length product (DLP) of coronary CTA was 195 mGy*cm (interquartile range 110-338 mGy*cm). When compared with 2007, the DLP was reduced by 78% (P < 0.001) without an increase in non-diagnostic coronary CTAs (1.7% in 2007 vs. 1.9% in 2017 surveys, P = 0.55). A 37-fold variability in median DLP was observed between the hospitals with lowest and highest DLP (range of median DLP 57-2090 mGy*cm). Independent predictors for radiation dose of coronary CTA were: body weight, heart rate, sinus rhythm, tube voltage, iterative image reconstruction, and the selection of scan protocols. Conclusion This large international radiation dose survey demonstrates considerable reduction of radiation exposure in coronary CTA during the last decade. However, the large inter-site variability in radiation exposure underlines the need for further site-specific training and adaptation of contemporary cardiac scan protocols.
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Affiliation(s)
- Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | | | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, USA
| | | | - Mathias Heckner
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - John Lesser
- Minneapolis Heart Institute at Abbott Northwestern Hosptial, Minneapolis, USA
| | | | - James Otton
- Spectrum Radiology Liverpool, Sydney, Australia
| | - Sanghoon Shin
- National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
| | | | - Hugo Marques
- UNICA (cardiovascular CT and MRI Unit), Hospital da Luz, Lisboa, Portugal
| | - Benjamin Chow
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | | | - Axel Schmermund
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt, Germany
| | | | | | | | | | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Fukui M, Tang L, Lesser J, Niikura H, Nunes M, Burns M, Schneider L, Han BK, Garcia S, Goessl M, Sorajja P, Cavalcante J. TCT-715 Anatomic Evaluation of Balloon-Expandable Transcatheter Aortic Valve Replacement: Computed Tomography Insights for Hypo-Attenuating Leaflet Thickening. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fukui M, Tang L, Lesser J, Niikura H, Nunes M, Burns M, Schneider L, Han BK, Garcia S, Goessl M, Sorajja P, Cavalcante J. TCT-751 Prevalence and Severity of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement Defined by Computed Tomography vs. Transthoracic Echocardiography. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Megaly M, Goessl M, Sorajja P, Anzia L, Henstrom J, Morley P, Garberich R, Bradley S, Tang C, Abdelhadi R, Poulose A, Lesser J, Garcia S, Sengupta J. TCT-534 Outcomes After Pacemaker Implantation in Patients With New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Megaly M, Garcia S, Anzia LE, Morley P, Garberich R, Gornick CC, Lesser J, Sorajja P, Gössl M, Sengupta J. Detection of Atrial Fibrillation and Atrial Flutter by Pacemaker Device Interrogation After Transcatheter Aortic Valve Replacement (TAVR): Implications for Management. J Invasive Cardiol 2019; 31:E177-E183. [PMID: 31257211] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) and atrial flutter (AFL) are associated with increased risk of stroke and mortality after transcatheter aortic valve replacement (TAVR). Many episodes of new-onset AF/AFL (NOAF) occur after hospital discharge and may not be clinically apparent. Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented AF. METHODS From 2012 to 2017, patients who underwent pacemaker implantation after TAVR were reviewed, and pacemaker data from device checks were analyzed for detection of NOAF. Patients with prior AF/AFL were excluded. Secondary outcomes were mortality and ischemic stroke. RESULTS A total of 172 patients underwent TAVR and pacemaker implantation, and 95 were without pre-existent AF/AFL. Over a median follow-up of 15 months, a total of 24 patients had NOAF (25%), of which 10 patients (10.5%) had manifest NOAF detected on electrocardiography, and 14 patients (14.7%) had subclinical NOAF first identified on device interrogation. The cumulative incidence of mortality was 16.7% for NOAF and 15.5% for normal sinus rhythm (P=.83). The cumulative incidence of stroke was 12.5% for NOAF and 1.4% for normal sinus rhythm (P=.04). Subclinical NOAF patients were less likely to be started on anticoagulation compared with manifest NOAF patients (70% vs 15.3%, respectively; P=.02). CONCLUSION Subclinical NOAF is common after TAVR, usually occurs months after hospital discharge, and is associated with lack of anticoagulation therapy and increased risk of stroke. Prolonged surveillance of subclinical NOAF may be warranted after TAVR.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jay Sengupta
- Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407 USA.
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Niikura H, Schwartz JG, Lin D, Lesser J, Sorajja P, Gössl M. Transcatheter closure of an aorto-right ventricular fistula after TAVR. Cardiovasc Interv Ther 2018; 34:290-292. [PMID: 30267384 DOI: 10.1007/s12928-018-0549-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Hiroki Niikura
- Valve Science Center at the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Jonathan G Schwartz
- Valve Science Center at the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - David Lin
- Valve Science Center at the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - John Lesser
- Valve Science Center at the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Paul Sorajja
- Valve Science Center at the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Mario Gössl
- Valve Science Center at the Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA.
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Tang L, Lesser J, Goessl M, Burns M, Schneider L, Niikura H, Witt D, Garberich R, Sorajja P. TCT-72 A Prospective Evaluation for Hypoattenuated Leaflet Thickening Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stocker TJ, Heckner M, Deseive S, Leipsic J, Chen M, Rubinshtein R, Hadamitzky M, Bax JJ, Grove E, Lesser J, Fang XM, Maurovich-Horvat P, Otton J, Shin S, Hausleiter J. P2484Radiation dose reduction in cardiac CT: results from the prospective multicenter registry on radiation dose estimates of cardiac CT angiography in daily practice in 2017. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T J Stocker
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - M Heckner
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - S Deseive
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - J Leipsic
- University of British Columbia, Vancouver, Canada
| | - M Chen
- National Institutes of Health, Bethesda, United States of America
| | | | - M Hadamitzky
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - J J Bax
- Leiden University Medical Center, Leiden, Netherlands
| | - E Grove
- Aarhus University Hospital, Aarhus, Denmark
| | - J Lesser
- Abbott Northwestern Hospital, Minneapolis, United States of America
| | - X M Fang
- Wuxi People's Hospital, Wuxi, China People's Republic of
| | | | - J Otton
- Spectrum Radiology Liverpool, Sydney, Australia
| | - S Shin
- Ilsan Hospital, Goyang, Korea Republic of
| | - J Hausleiter
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
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Sorajja P, Nelson P, Garberich R, Bradley SM, Athappan G, Bae R, Harris K, Lesser J, Tindell L, Farivar RS, Goessl M. Clinical Impact of Chronic Aortic Regurgitation in Asymptomatic Patients with Native Aortic Valve Stenosis. Structural Heart 2018. [DOI: 10.1080/24748706.2018.1479078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - Patrick Nelson
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - Ross Garberich
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - Steven M. Bradley
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - Ganesh Athappan
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - Richard Bae
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - Kevin Harris
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - John Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - Lisa Tindell
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - R. Saeid Farivar
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
| | - Mario Goessl
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital , Minneapolis, Minnesota, USA
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Han BK, Casey S, Witt D, Leipsic J, Crean A, Nicol E, Semple T, Shambrook J, Prakash A, Banka P, Garberich R, Rigsby C, Hlavacek A, Lesser J. Development of a congenital cardiovascular computed tomography imaging registry: Rationale and implementation. J Cardiovasc Comput Tomogr 2018; 12:263-266. [PMID: 29628189 DOI: 10.1016/j.jcct.2018.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The cumulative exposure and risk of anesthesia, vascular access, contrast agents and radiation is emerging as a significant lifelong burden in patients with congenital heart disease (CHD). Latest generation computerized tomographic (CT) scanners are increasingly used for high resolution cardiovascular imaging and have both hardware and post processing radiation dose reduction strategies that can be implemented. Currently, these dose reduction strategies are not uniformly applied and there is a large variability in radiation dose used for the performance of CT in CHD. METHODS We propose the development and implementation of a prospective, multi-center and multi-specialty consortium to measure the variability of use, risk and image quality of CT scans in patients of all ages with CHD. The primary goals of this collaboration are 1) define variability of use, diagnostic quality, and risk of cardiac CT 2) establish best practice guidelines designed to optimize diagnostic image quality with appropriate use of radiation and anesthesia exposure 3) provide institution specific feedback compared with the group norm across participating centers 4) improve the level of evidence for the use of CT in CHD through the collection of prospective and multi-institutional data. CONCLUSIONS Prospective multi-institutional data is needed to inform risk estimates of CT in CHD using current generation scanners and aggressive dose optimization techniques. This registry will provide a platform for future collaboration establishing a multi-modality risk assessment tool specific to patients with CHD.
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Affiliation(s)
- B Kelly Han
- Children's Heart Clinic at Children's Hospitals and Clinics of Minnesota, USA.
| | - Susan Casey
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Dawn Witt
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Jonathon Leipsic
- University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | | | | | | | | | - Ashwin Prakash
- The Heart Center at Boston Children's Hospital, Boston, MA, USA
| | - Puja Banka
- The Heart Center at Boston Children's Hospital, Boston, MA, USA
| | - Ross Garberich
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Cynthia Rigsby
- Ann and Robert H. Lurie's Children's Hospital, Chicago, IL, USA
| | | | - John Lesser
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA
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Stocker TJ, Deseive S, Chen M, Leipsic J, Hadamitzky M, Rubinshtein R, Grove EL, Fang XM, Lesser J, Maurovich-Horvat P, Marques H, Andreini D, Tabbalat R, Kang JW, Eckert J, Dickson P, Forsdahl SH, Lambrechtsen J, Cury RC, Hausleiter J. Rationale and design of the worldwide prospective multicenter registry on radiation dose estimates of cardiac CT angiography in daily practice in 2017 (PROTECTION VI). J Cardiovasc Comput Tomogr 2017; 12:81-85. [PMID: 29233632 DOI: 10.1016/j.jcct.2017.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/04/2017] [Accepted: 11/30/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiac computed tomography angiography (cardiac CTA) is an increasingly used versatile imaging method to evaluate coronary and cardiac morphology. Owing to improvements in technology, image quality has continuously improved over the last 10-20 years. At the same time, numerous non-randomized and randomized studies have been performed to reduce the associated radiation exposure. Currently, it is unclear if the advances in technology and knowledge about radiation reduction translated into reduced levels of cardiac CTA radiation dose in daily clinical practice as well as a wide utilization of dose-saving strategies. METHODS The PROTECTION VI study is a multicenter, prospective, worldwide registry designed to evaluate radiation dose exposure, utilization of dose-saving strategies and diagnostic image quality during cardiac CTA in current daily practice. Assessment of image quality will be addressed by the evaluation of diagnostic image quality at the local study site and the calculation of quantitative image quality parameters in an imaging core laboratory. Above 4000 patients will be enrolled from approximately 70 sites in Europe, North America, South America, Asia and Australia. The study will analyze median radiation dose levels, image quality, frequency of use and efficacy of algorithms for dose reduction, and patient and study-related predictors associated with radiation dose. CONCLUSIONS The PROTECTION VI study is designed to provide a reliable estimate of current radiation dose for cardiac CTA and to assess the potential for additional dose reductions.
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Affiliation(s)
- Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany
| | - Marcus Chen
- National Heart, Lung, and Blood Institute, Bethesda, United States
| | | | | | | | | | | | - John Lesser
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, United States
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Budapest, Hungary
| | - Hugo Marques
- UNICA (Cardiovascular Imaging Unit), Hospital da Luz, Lisbon, Portugal
| | | | | | | | - Joachim Eckert
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt, Germany
| | | | | | | | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany.
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Taylor CA, Gaur S, Leipsic J, Achenbach S, Berman DS, Jensen JM, Dey D, Bøtker HE, Kim HJ, Khem S, Wilk A, Zarins CK, Bezerra H, Lesser J, Ko B, Narula J, Ahmadi A, Øvrehus KA, St Goar F, De Bruyne B, Nørgaard BL. Effect of the ratio of coronary arterial lumen volume to left ventricle myocardial mass derived from coronary CT angiography on fractional flow reserve. J Cardiovasc Comput Tomogr 2017; 11:429-436. [PMID: 28789941 DOI: 10.1016/j.jcct.2017.08.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [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: 02/05/2017] [Revised: 06/14/2017] [Accepted: 08/01/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND We hypothesize that in patients with suspected coronary artery disease (CAD), lower values of the ratio of total epicardial coronary arterial lumen volume to left ventricular myocardial mass (V/M) result in lower fractional flow reserve (FFR). METHODS V/M was computed in 238 patients from the NXT trial who underwent coronary computed tomography angiography (CTA), quantitative coronary angiography (QCA) and FFR measurement in 438 vessels. Nitroglycerin was administered prior to CT, QCA and FFR acquisition. The V/M ratio was quantified on a patient-level from CT image data by segmenting the epicardial coronary arterial lumen volume (V) and the left ventricular myocardial mass (M). Calcified and noncalcified plaque volumes were quantified using semi-automated software. RESULTS The median value of V/M (18.57 mm3/g) was used to define equal groups of low and high V/M patients. Patients with low V/M had greater diameter stenosis by QCA, more plaque and lower FFR (0.80 ± 0.12 vs. 0.87 ± 0.08; P < 0.0001) than those with high V/M. A total of 365 vessels in 202 patients had QCA stenosis ≤50% and measured FFR. In these patients, those with low V/M had higher percent diameter stenosis by QCA, greater total plaque volume and lower FFR (0.81 ± 0.12 vs. 0.88 ± 0.07; P < 0.0001) than those with high V/M. In multivariate logistic regression analysis, V/M was an independent predictor of FFR ≤0.80 (all p-values < 0.001). CONCLUSIONS Patients with a low V/M ratio have lower FFR overall and in non-obstructive CAD, independent of plaque measures.
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Affiliation(s)
- Charles A Taylor
- HeartFlow, Inc., Redwood City, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA.
| | - Sara Gaur
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Jonathon Leipsic
- Department of Radiology and Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Daniel S Berman
- Department of Cardiology, Cedars Sinai Hospital, Los Angeles, CA, USA
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Damini Dey
- Department of Cardiology, Cedars Sinai Hospital, Los Angeles, CA, USA
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | | | | | - Alan Wilk
- HeartFlow, Inc., Redwood City, CA, USA
| | | | - Hiram Bezerra
- Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland, Ohio, USA
| | - John Lesser
- Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Brian Ko
- Monash Heart, Monash Medical Center and Monash University, Victoria, Australia
| | - Jagat Narula
- Department of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Amir Ahmadi
- Department of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Kristian A Øvrehus
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Fred St Goar
- Department of Cardiology, El Camino Hospital, Mountain View, CA, USA
| | | | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
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Saadatmand H, Wu C, Lesser J, Isaacson S, Wang T, Sisti M. Improved Outcomes in Acoustic Neuroma Patients Receiving Stereotactic Radiosurgery from a Single Neurosurgeon at a High-Volume Institution. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Han BK, Taylor M, Baker C, Grant K, Lesser J, Overman D. COMPUTED TOMOGRAPHY ANGIOGRAPHY FOR ASSESSMENT OF ANATOMY THROUGH ALL STAGES OF SINGLE VENTRICLE PALLIATION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31758-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maurer MS, Ginns J, Maron B, Olivotto I, Lesser J, Gruner C, Crean A, Rakowski H, Rowin E, Lombardi M, Spirito P, Biagini E, Autore C, Manning W, Tomberli B, Maron M, Chan R. THE MYOCARDIAL CONTRACTION FRACTION (MCF) IS ASSOCIATED WITH NYHA CLASS AS WELL AS DELAYED ENHANCEMENT BY CARDIAC MRI IN HYPERTROPHIC CARDIOMYOPATHY AND PREDICTS SUDDEN CARDIAC DEATH. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sorajja P, Pedersen W, Bae R, Lesser J, Jay D, Harris K, Maron B. FIRST EXPERIENCE WITH PERCUTANEOUS MITRAL VALVE PLICATION AS PRIMARY THERAPY FOR SYMPTOMATIC OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sorajja P, Ahmed A, Bae R, Lesser J, Pedersen W, Tindell L, Harris K, Farivar R. PATTERNS AND PREDICTORS OF STROKE VOLUME CHANGE WITH TRANSCATHETER AORTIC VALVE REPLACEMENT FOR LOW-GRADIENT AORTIC STENOSIS AND NORMAL EJECTION FRACTION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30127-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sorajja P, Nelson P, Bae R, Sandoval Y, Lesser J, Pedersen W, Tindell L, Harris K, Farivar R. ADVERSE IMPACT OF AORTIC REGURGITATION ON THE LONG-TERM SURVIVAL OF PATIENTS WITH NATIVE AORTIC VALVE STENOSIS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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