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Kwiecinski J, Dabrowski M, Nombela-Franco L, Grodecki K, Pieszko K, Chmielak Z, Pylko A, Hennessey B, Kalinczuk L, Tirado-Conte G, Rymuza B, Kochman J, Opolski MP, Huczek Z, Dweck MR, Dey D, Jimenez-Quevedo P, Slomka P, Witkowski A. Machine learning for prediction of all-cause mortality after transcatheter aortic valve implantation. Eur Heart J Qual Care Clin Outcomes 2023; 9:768-777. [PMID: 36637410 PMCID: PMC10745254 DOI: 10.1093/ehjqcco/qcad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/18/2022] [Accepted: 01/11/2023] [Indexed: 01/14/2023]
Abstract
AIMS Prediction of adverse events in mid-term follow-up after transcatheter aortic valve implantation (TAVI) is challenging. We sought to develop and validate a machine learning model for prediction of 1-year all-cause mortality in patients who underwent TAVI and were discharged following the index procedure. METHODS AND RESULTS The model was developed on data of patients who underwent TAVI at a high-volume centre between January 2013 and March 2019. Machine learning by extreme gradient boosting was trained and tested with repeated 10-fold hold-out testing using 34 pre- and 25 peri-procedural clinical variables. External validation was performed on unseen data from two other independent high-volume TAVI centres. Six hundred four patients (43% men, 81 ± 5 years old, EuroSCORE II 4.8 [3.0-6.3]%) in the derivation and 823 patients (46% men, 82 ± 5 years old, EuroSCORE II 4.7 [2.9-6.0]%) in the validation cohort underwent TAVI and were discharged home following the index procedure. Over the 12 months of follow-up, 68 (11%) and 95 (12%) subjects died in the derivation and validation cohorts, respectively. In external validation, the machine learning model had an area under the receiver-operator curve of 0.82 (0.78-0.87) for prediction of 1-year all-cause mortality following hospital discharge after TAVI, which was superior to pre- and peri-procedural clinical variables including age 0.52 (0.46-0.59) and the EuroSCORE II 0.57 (0.51-0.64), P < 0.001 for a difference. CONCLUSION Machine learning based on readily available clinical data allows accurate prediction of 1-year all-cause mortality following a successful TAVI.
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Affiliation(s)
- Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
- Departments of Medicine (Division of Artificial Intelligence in Medicine) and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Metro 203, Los Angeles, CA 90048, USA
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Konrad Pieszko
- Departments of Medicine (Division of Artificial Intelligence in Medicine) and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Metro 203, Los Angeles, CA 90048, USA
- Department of Interventional Cardiology and Cardiac Surgery, University of Zielona Gora, Zielona Gora, Poland
| | - Zbigniew Chmielak
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Anna Pylko
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Breda Hennessey
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Lukasz Kalinczuk
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | | | - Bartosz Rymuza
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine) and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Metro 203, Los Angeles, CA 90048, USA
| | | | - Piotr Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine) and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Metro 203, Los Angeles, CA 90048, USA
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
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2
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Patel KP, Lin A, Kumar N, Esposito G, Grodecki K, Lloyd G, Mathur A, Baumbach A, Mullen MJ, Williams MC, Newby DE, Treibel TA, Dweck MR, Dey D. Influence of cusp morphology and sex on quantitative valve composition in severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2023; 24:1653-1660. [PMID: 37339331 DOI: 10.1093/ehjci/jead142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/09/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
AIMS Aortic stenosis is characterized by fibrosis and calcification of the valve, with a higher proportion of fibrosis observed in women. Stenotic bicuspid aortic valves progress more rapidly than tricuspid valves, which may also influence the relative composition of the valve. We aimed to investigate the influence of cusp morphology on quantitative aortic valve composition quantified from contrast-enhanced computed tomography angiography in severe aortic stenosis. METHODS AND RESULTS Patients undergoing transcatheter aortic valve implantation with bicuspid and tricuspid valves were propensity matched 1:1 by age, sex, and comorbidities. Computed tomography angiograms were analysed using semi-automated software to quantify the fibrotic and calcific scores (volume/valve annular area) and the fibro-calcific ratio (fibrotic score/calcific score). The study population (n = 140) was elderly (76 ± 10 years, 62% male) and had a peak aortic jet velocity of 4.1 ± 0.7 m/s. Compared with those with tricuspid valves (n = 70), patients with bicuspid valves (n = 70) had higher fibrotic scores [204 (interquartile range 118-267) vs. 144 (99-208) mm3/cm2, P = 0.006] with similar calcific scores (P = 0.614). Women had greater fibrotic scores than men in bicuspid [224 (181-307) vs. 169 (109-247) mm3/cm2, P = 0.042] but not tricuspid valves (P = 0.232). Men had greater calcific scores than women in both bicuspid [203 (124-355) vs. 130 (70-182) mm3/cm2, P = 0.008] and tricuspid [177 (136-249) vs. 100 (62-150) mm3/cm2, P = 0.004] valves. Among both valve types, women had a greater fibro-calcific ratio compared with men [tricuspid 1.86 (0.94-2.56) vs. 0.86 (0.54-1.24), P = 0.001 and bicuspid 1.78 (1.21-2.90) vs. 0.74 (0.44-1.53), P = 0.001]. CONCLUSIONS In severe aortic stenosis, bicuspid valves have proportionately more fibrosis than tricuspid valves, especially in women.
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Affiliation(s)
- Kush P Patel
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Andrew Lin
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, 116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
| | - Niraj Kumar
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Giulia Esposito
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Kajetan Grodecki
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, 116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
- First Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Guy Lloyd
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Andreas Baumbach
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - David E Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Thomas A Treibel
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marc R Dweck
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, 116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
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3
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Wilimski R, Huczek Z, Krauz K, Rymuza B, Mazurek M, Scisło P, Zbroński K, Grodecki K, Kochman J, Kuśmierczyk M. Impact of previous coronary artery revascularization on outcomes in patients undergoing transcatheter aortic valve implantation. Postepy Kardiol Interwencyjnej 2023; 19:243-250. [PMID: 37854973 PMCID: PMC10580857 DOI: 10.5114/aic.2023.131477] [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: 05/19/2023] [Accepted: 07/03/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Coexistence of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) raises questions regarding the safety and efficacy of TAVI in this subset of patients. Aim To evaluate the impact of previous coronary revascularization in terms of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on clinical outcomes after TAVI. Material and methods A total of 507 consecutive patients who underwent TAVI were divided into: non-revascularization (NR), post-PCI and post-CABG groups. The endpoints were established according to VARC-2 definitions. Results Patients with previous coronary revascularization (36.7% of the population) were younger, more often male and their EuroSCORE II risk evaluation was significantly higher (NR 7.9% vs. post-PCI 8.0% vs. post-CABG 20.5%, p < 0.0001). Patients after PCI or CABG prior to TAVI had similar 30-day all-cause mortality rates as those without coronary revascularization at baseline (NR vs. post-PCI vs. post-CABG: 8.1% vs. 5.5% vs. 6.8%, respectively; p = 0.6). There were no differences in 12-month all-cause mortality rates between groups (NR vs. post-PCI vs. post-CABG: 15.3% vs. 14.2% vs. 16.9%, respectively; log-rank p = 0.67). In the Cox proportional-hazards regression model, acute kidney injury stage 2-3 (HR = 3.7, 95% CI: 2.14-6.33; p < 0.001) and post-TAVI stroke (HR = 3.5, 95% CI: 1.57-7.8; p = 0.002) were independently correlated with 1-year mortality. Conclusions TAVI seems to be a safe and effective procedure for the treatment of severe AS in patients with previous coronary revascularization.
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Affiliation(s)
- Radosław Wilimski
- Department of Cardio-Thoracic Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - Zenon Huczek
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Kamil Krauz
- Department of Cardio-Thoracic Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Rymuza
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Mazurek
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Scisło
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Karol Zbroński
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Kajetan Grodecki
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- 1 Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Department of Cardio-Thoracic Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
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4
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Grodecki K, Killekar A, Simon J, Lin A, Cadet S, McElhinney P, Chan C, Williams MC, Pressman BD, Julien P, Li D, Chen P, Gaibazzi N, Thakur U, Mancini E, Agalbato C, Munechika J, Matsumoto H, Menè R, Parati G, Cernigliaro F, Nerlekar N, Torlasco C, Pontone G, Maurovich-Horvat P, Slomka PJ, Dey D. Artificial intelligence-assisted quantification of COVID-19 pneumonia burden from computed tomography improves prediction of adverse outcomes over visual scoring systems. Br J Radiol 2023; 96:20220180. [PMID: 37310152 PMCID: PMC10461277 DOI: 10.1259/bjr.20220180] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/15/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the effectiveness of utilizing artificial intelligence (AI) to quantify the extent of pneumonia from chest CT scans, and to determine its ability to predict clinical deterioration or mortality in patients admitted to the hospital with COVID-19 in comparison to semi-quantitative visual scoring systems. METHODS A deep-learning algorithm was utilized to quantify the pneumonia burden, while semi-quantitative pneumonia severity scores were estimated through visual means. The primary outcome was clinical deterioration, the composite end point including admission to the intensive care unit, need for invasive mechanical ventilation, or vasopressor therapy, as well as in-hospital death. RESULTS The final population comprised 743 patients (mean age 65 ± 17 years, 55% men), of whom 175 (23.5%) experienced clinical deterioration or death. The area under the receiver operating characteristic curve (AUC) for predicting the primary outcome was significantly higher for AI-assisted quantitative pneumonia burden (0.739, p = 0.021) compared with the visual lobar severity score (0.711, p < 0.001) and visual segmental severity score (0.722, p = 0.042). AI-assisted pneumonia assessment exhibited lower performance when applied for calculation of the lobar severity score (AUC of 0.723, p = 0.021). Time taken for AI-assisted quantification of pneumonia burden was lower (38 ± 10 s) compared to that of visual lobar (328 ± 54 s, p < 0.001) and segmental (698 ± 147 s, p < 0.001) severity scores. CONCLUSION Utilizing AI-assisted quantification of pneumonia burden from chest CT scans offers a more accurate prediction of clinical deterioration in patients with COVID-19 compared to semi-quantitative severity scores, while requiring only a fraction of the analysis time. ADVANCES IN KNOWLEDGE Quantitative pneumonia burden assessed using AI demonstrated higher performance for predicting clinical deterioration compared to current semi-quantitative scoring systems. Such an AI system has the potential to be applied for image-based triage of COVID-19 patients in clinical practice.
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Affiliation(s)
| | - Aditya Killekar
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cato Chan
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Michelle C. Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Barry D. Pressman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Peter Julien
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Peter Chen
- Department of Medicine, Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nicola Gaibazzi
- Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | | | - Cecilia Agalbato
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Jiro Munechika
- Division of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | | | - Piotr J. Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Olasińska-Wiśniewska A, Urbanowicz T, Grodecki K, Kübler P, Perek B, Grygier M, Misterski M, Walczak M, Szot M, Jemielity M. Monocyte-to-lymphocyte ratio correlates with parathyroid hormone concentration in patients with severe symptomatic aortic stenosis. Adv Med Sci 2023; 68:396-401. [PMID: 37837798 DOI: 10.1016/j.advms.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/17/2023] [Accepted: 09/25/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE The normal healthy valve is devoid of inflammatory cells, however background of aortic stenosis (AS) may include inflammatory processes. Moreover, the link between hyperparathyroidism and heart failure is postulated. Simple whole blood analysis with indices is a beneficial tool in cardiovascular diseases' assessment. The purpose of the study was to evaluate correlation between parathyroid hormone (PTH) and simple blood parameters in severe AS. MATERIAL AND METHODS The study included 62 patients with severe AS. Patients with inflammatory or autoimmune co-morbidities were excluded. Blood samples were collected, and clinical and demographic data were analyzed. RESULTS The final study group comprised 55 patients (31 females, 56.4%; mean age 77.13 (SD 6.76)). In 23 patients (41.8%), PTH concentration was markedly increased. The study group was divided into two subgroups according to the PTH concentration. Patients from both groups did not differ significantly in terms of age and co-morbidities. PTH concentration correlated positively with monocyte-lymphocyte ratio (MLR) (p = 0.008, Spearman rho 0.356) and platelet-lymphocyte ratio (PLR) (p = 0.047, Spearman rho 0.269), creatinine level (p = 0.001, Spearman rho 0.425) and glomerular filtration rate (GFR-MDRD) (p = 0.009, Spearman rho -0.349). The multivariable logistic regression with backward analysis revealed MLR (p = 0.029) and GFR (p = 0.028) as independent significant predictors of abnormal PTH values. The receiver operator characteristics (ROC) curve was performed for the model of MLR and GFR-MDRD (AUC = 0.777), yielding the sensitivity of 60.9% and specificity of 90.6%. CONCLUSIONS PTH concentration correlates with monocyte-to-lymphocyte and platelet-to-lymphocyte ratios in calcified AS.
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Affiliation(s)
- Anna Olasińska-Wiśniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
| | - Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kajetan Grodecki
- I Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kübler
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Grygier
- I Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Misterski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Walczak
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Szot
- Cardiac Surgery Students' Scientific Group, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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6
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Kuronuma K, van Diemen PA, Han D, Lin A, Grodecki K, Kwiecinski J, Motwani M, McElhinney P, Tomasino GF, Park C, Kwan A, Tzolos E, Klein E, Shou B, Tamarappoo B, Cadet S, Danad I, Driessen RS, Berman DS, Slomka PJ, Dey D, Knaapen P. Relationship between impaired myocardial blood flow by positron emission tomography and low-attenuation plaque burden and pericoronary adipose tissue attenuation from coronary computed tomography: From the prospective PACIFIC trial. J Nucl Cardiol 2023; 30:1558-1569. [PMID: 36645580 DOI: 10.1007/s12350-022-03194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/02/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Positron emission tomography (PET) is the clinical gold standard for quantifying myocardial blood flow (MBF). Pericoronary adipose tissue (PCAT) attenuation may detect vascular inflammation indirectly. We examined the relationship between MBF by PET and plaque burden and PCAT on coronary CT angiography (CCTA). METHODS This post hoc analysis of the PACIFIC trial included 208 patients with suspected coronary artery disease (CAD) who underwent [15O]H2O PET and CCTA. Low-attenuation plaque (LAP, < 30HU), non-calcified plaque (NCP), and PCAT attenuation were measured by CCTA. RESULTS In 582 vessels, 211 (36.3%) had impaired per-vessel hyperemic MBF (≤ 2.30 mL/min/g). In multivariable analysis, LAP burden was independently and consistently associated with impaired hyperemic MBF (P = 0.016); over NCP burden (P = 0.997). Addition of LAP burden improved predictive performance for impaired hyperemic MBF from a model with CAD severity and calcified plaque burden (P < 0.001). There was no correlation between PCAT attenuation and hyperemic MBF (r = - 0.11), and PCAT attenuation was not associated with impaired hyperemic MBF in univariable or multivariable analysis of all vessels (P > 0.1). CONCLUSION In patients with stable CAD, LAP burden was independently associated with impaired hyperemic MBF and a stronger predictor of impaired hyperemic MBF than NCP burden. There was no association between PCAT attenuation and hyperemic MBF.
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Affiliation(s)
- Keiichiro Kuronuma
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Cardiology, Nihon University, Tokyo, Japan
| | | | - Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Manish Motwani
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Guadalupe Flores Tomasino
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Caroline Park
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Alan Kwan
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Eyal Klein
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin Shou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Balaji Tamarappoo
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA.
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
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7
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Huczek Z, Protasiewicz M, Dąbrowski M, Parma R, Hudziak D, Olszówka P, Targoński R, Grodecki K, Frank M, Scisło P, Kralisz P, Trębacz J, Sacha J, Wilczek K, Walczak A, Smolka G, Kleczyński P, Milewski K, Hawranek M, Kochman J, Lesiak M, Dudek D, Witkowski A, Legutko J, Bartuś S, Wilimski R, Wojakowski W, Grygier M. Transcatheter aortic valve implantation for failed surgical and transcatheter prostheses. Expert Opinion of the Association of Percutaneous Cardiovascular Interventions of the Polish Cardiac Society. Kardiol Pol 2023:VM/OJS/J/96066. [PMID: 37319015 DOI: 10.33963/kp.a2023.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland.
| | - Marcin Protasiewicz
- Department and Clinic of Cardiology, Wrocław Medical University, Wrocław, Poland
| | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Radosław Parma
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Piotr Olszówka
- Department of Cardiac Surgery, District Hospital No. 2, Rzeszów, Poland
| | - Radosław Targoński
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Marek Frank
- Department of Cardiac Surgery, Medical University of Bialystok, Białystok, Poland
| | - Piotr Scisło
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Paweł Kralisz
- Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Jarosław Trębacz
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Jerzy Sacha
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Krzysztof Wilczek
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Zabrze, Poland
- Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Andrzej Walczak
- Department of Cardiac Surgery, Medical University of Łódz, Łódź, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Paweł Kleczyński
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Michał Hawranek
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Zabrze, Poland
- Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Dariusz Dudek
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kraków, Poland
- Maria Cecilia Hospital, Cotignola RA, Italy
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Jacek Legutko
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Warszawa, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
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Olasińska-Wiśniewska A, Urbanowicz T, Gładki M, Grodecki K, Michalak M, Węclewska A, Sochacki M, Bobkowski W, Zalas D, Jemielity M. Red blood cell distribution width as a prognostic marker of prolonged mechanical ventilation after paediatric cardiac surgery. Arch Med Sci 2023; 19:825-828. [PMID: 37313203 PMCID: PMC10259390 DOI: 10.5114/aoms/161247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/14/2023] [Indexed: 06/15/2023] Open
Affiliation(s)
- Anna Olasińska-Wiśniewska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Gładki
- Pediatric Cardiac Surgery Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Kajetan Grodecki
- I Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - Waldemar Bobkowski
- Pediatric Cardiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Dominika Zalas
- Pediatric Cardiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
- Pediatric Cardiac Surgery Department, Poznan University of Medical Sciences, Poznan, Poland
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9
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Grodecki K, Warniello M, Spiewak M, Kwiecinski J. Advanced Cardiac Imaging in the Assessment of Aortic Stenosis. J Cardiovasc Dev Dis 2023; 10:jcdd10050216. [PMID: 37233183 DOI: 10.3390/jcdd10050216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Aortic stenosis is the most common form of valve disease in the Western world and a major healthcare burden. Although echocardiography remains the central modality for the diagnosis and assessment of aortic stenosis, recently, advanced cardiac imaging with cardiovascular magnetic resonance, computed tomography, and positron emission tomography have provided invaluable pathological insights that may guide the personalized management of the disease. In this review, we discuss applications of these novel non-invasive imaging modalities for establishing the diagnosis, monitoring disease progression, and eventually planning the invasive treatment of aortic stenosis.
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Affiliation(s)
- Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Mateusz Warniello
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Mateusz Spiewak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
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10
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Huczek Z, Mazurek M, Kochman J, Kralisz P, Jagielak D, Sacha J, Frank M, Targoński R, Walczak A, Rymuza B, Grodecki K, Scisło P, Jędrzejczyk S, Jańczak J, Pysz P, Rudziński PN, Demkow M, Witkowski A, Grygier M, Wojakowski W. Valve-in-valve transcatheter transfemoral mitral valve implantation (ViV-TMVI): Characteristics and early results from nationwide registry. Kardiol Pol 2023:VM/OJS/J/93805. [PMID: 37096948 DOI: 10.33963/kp.a2023.0094] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/22/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Valve-in-valve transcatheter transfemoral mitral valve implantation (ViV-TMVI) is an emerging treatment alternative to reoperation in high surgical risk patients with a failed mitral bioprostheses. AIM To describe characteristics and evaluate 30-day outcomes of ViV-TMVI in the Polish population. METHODS Nationwide registry was initiated to collect data of all patients with failed mitral bioprosthesis undergoing ViV-TMVI in Poland. This study presents 30-days clinical and echocardiographic follow-up. RESULTS Overall, 27 ViV-TMVI were performed in 8 centers until May 2022 (85% since 2020). Mean (standard deviation [SD]) age was 73 (11.6) years with the median (interquartile range [IQR]) STS score of 5.3% (4.3%-14.3%). Mean (SD) time between surgical implantation and ViV-TMVI was 8.2 (3.2) years. Failed Hancock II (29%) and Perimount Magna (22%) were most frequently treated. Mechanisms of failure were equally often pure mitral regurgitation or stenosis (both 37%) with mixed etiology in 26%. Balloon-expandable Sapien 3/Ultra were used in all but 1 patient. Technical success was 96.3% (1 patient required additional prosthesis). Mean (SD) transvalvular mitral gradient reached 6.7 (2.2) mm Hg and mitral valve area was 1.8 (0.4) cm². None of the patients had moderate or severe mitral regurgitation with only 14.8% graded as mild. In 92.6% device success (2 patients had mean gradient ≥10 mm Hg) and in 85.6% procedural success was present. There were no deaths, cerebrovascular events or need for mitral valve surgery during 30-day follow-up. CONCLUSIONS In short-term observation ViV-TMVI is safe and effective alternative for patients with failed mitral bioprosthesis at high surgical risk of re-operation. Longer observations on larger sample are warranted.
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Affiliation(s)
- Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Maciej Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland.
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Paweł Kralisz
- Department of Invasive Cardiology, Medical University of Białystok, Białystok, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jerzy Sacha
- Department of Cardiology, University Hospital in Opole, Opole, Poland
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Marek Frank
- Department of Cardiac Surgery, Medical University of Białystok, Białystok, Poland
| | - Radosław Targoński
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Walczak
- Department of Cardiac Surgery, Medical University of Łódz, Łódz, Poland
| | - Bartosz Rymuza
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Piotr Scisło
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Szymon Jędrzejczyk
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Jakub Jańczak
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Piotr Pysz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Piotr Nikodem Rudziński
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warszawa, Poland
| | - Marcin Demkow
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warszawa, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Marek Grygier
- Chair and 1st Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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11
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Han D, van Diemen P, Kuronuma K, Lin A, Motwani M, McElhinney P, Tomasino GF, Park C, Kwan A, Tzolos E, Klein E, Grodecki K, Shou B, Tamarappoo B, Cadet S, Danad I, Driessen RS, Berman DS, Slomka PJ, Dey D, Knaapen P. Sex differences in computed tomography angiography-derived coronary plaque burden in relation to invasive fractional flow reserve. J Cardiovasc Comput Tomogr 2023; 17:112-119. [PMID: 36670043 PMCID: PMC10148895 DOI: 10.1016/j.jcct.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Distinct sex-related differences exist in coronary artery plaque burden and distribution. We aimed to explore sex differences in quantitative plaque burden by coronary CT angiography (CCTA) in relation to ischemia by invasive fractional flow reserve (FFR). METHODS This post-hoc analysis of the PACIFIC trial included 581 vessels in 203 patients (mean age 58.1 ± 8.7 years, 63.5% male) who underwent CCTA and per-vessel invasive FFR. Quantitative assessment of total, calcified, non-calcified, and low-density non-calcified plaque burden were performed using semiautomated software. Significant ischemia was defined as invasive FFR ≤0.8. RESULTS The per-vessel frequency of ischemia was higher in men than women (33.5% vs. 7.5%, p < 0.001). Women had a smaller burden of all plaque subtypes (all p < 0.01). There was no sex difference on total, calcified, or non-calcified plaque burdens in vessels with ischemia; only low-density non-calcified plaque burden was significantly lower in women (beta: -0.183, p = 0.035). The burdens of all plaque subtypes were independently associated with ischemia in both men and women (For total plaque burden (5% increase): Men, OR: 1.15, 95%CI: 1.06-1.24, p = 0.001; Women, OR: 1.96, 95%CI: 1.11-3.46, p = 0.02). No significant interaction existed between sex and total plaque burden for predicting ischemia (interaction p = 0.108). The addition of quantitative plaque burdens to stenosis severity and adverse plaque characteristics improved the discrimination of ischemia in both men and women. CONCLUSIONS In symptomatic patients with suspected CAD, women have a lower CCTA-derived burden of all plaque subtypes compared to men. Quantitative plaque burden provides independent and incremental predictive value for ischemia, irrespective of sex.
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Affiliation(s)
- Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Pepijn van Diemen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Keiichiro Kuronuma
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Manish Motwani
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Caroline Park
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Kwan
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Eyal Klein
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin Shou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Balaji Tamarappoo
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cardiovascular Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sebastien Cadet
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Roel S Driessen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Daniel S Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Artificial Interlligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
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Wilimski R, Huczek Z, Grodecki K, Kochman J, Rymuza B, Wojakowski W, Hudziak D, Jagielak D, Sacha J, Grygier M, Walczak A, Hendzel P, Cichoń R, Grabowski M, Kuśmierczyk M. Nationwide experience with transcarotid transcatheter aortic valve implantation: Insights from the POL-CAROTID registry. Kardiol Pol 2023; 81:373-380. [PMID: 36594529 DOI: 10.33963/kp.a2022.0288] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND: To investigate the feasibility and safety of transcarotid (TC) access for transcatheter aortic valve implantation (TAVI) in comparison to the transfemoral (TF) approach in a multicenter setting. METHODS: A total of 41 patients, treated between December 2014 and December 2018, were retrospectively reported to the Polish Registry of Common Carotid Artery Access for TAVI (POL-CAROTID). The median follow-up time was 619 (365 - 944) days and Valve Academic Research Consortium-2 (VARC-2) definitions were applied. Clinical outcomes were compared with 41 propensity-matched TF-TAVI patients. RESULTS: The mean (SD) patients' age was 78.0 (7.2) years and 29 patients (70.7%) were men. Prohibitive iliofemoral anatomy and/or obesity (46.3%) and/or the presence of stent graft in the abdominal aorta (31.7%) were the most common indications for TC-TAVI. Device success for TC-TAVI was comparable with matched TF-TAVI group (90.2% vs 95.3%, P=0.396) and no periprocedural mortality was observed. Moreover, early safety was similar between the two groups (92.7% vs 95.3%, respectively, log-rank P=0.658) with only 1 case of non-disabling stroke during the first month after TC-TAVI. Consequently, no cerebrovascular events were observed in the mid-term, and the clinical efficacy of TC-TAVI corresponded well with TF-TAVI (90.2% vs 92.7%, log-rank P=0.716). A total of 4 (9.8%) deaths were noted in the TC-TAVI cohort in comparison to 3 (7.3%) in the TF-TAVI group. CONCLUSIONS: The results of the study indicated that the first cohort of transcarotid transcatheter heart valves of second-generation implantations in Poland were associated with a similar prognosis to TF-TAVI with regard to safety and feasibility. TC access may be considered an optimal alternative for patients, in whom the TF approach is precluded.
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Affiliation(s)
- Radoslaw Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Warszawa, Poland.
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Bartosz Rymuza
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland
| | - Damian Hudziak
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia, Katowice, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Jerzy Sacha
- Department of Cardiology, University Hospital, Faculty of Natural Sciences and Technology, University of Opole, Opole, Poland.,Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Andrzej Walczak
- Department of Cardiac Surgery, Medical University of Lodz, Łódź, Poland
| | - Piotr Hendzel
- Department of Cardiac Surgery, Medical University of Warsaw, Warszawa, Poland
| | - Romuald Cichoń
- Department of Cardiac Surgery, Medical University of Zielona Góra, Zielona Góra, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Mariusz Kuśmierczyk
- Department of Cardiac Surgery, Medical University of Warsaw, Warszawa, Poland
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13
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Urbanowicz T, Olasińska-Wiśniewska A, Grodecki K, Fryska Z, Komosa A, Uruski P, Radziemski A, Filipiak KJ, Tykarski A, Jemielity M. Large unstained cells count is a useful predictor of coronary artery disease co-existence in patients with severe aortic stenosis. Kardiol Pol 2023; 81:769-771. [PMID: 37711047 DOI: 10.33963/kp.a2023.0111] [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] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland.
| | - Anna Olasińska-Wiśniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Kajetan Grodecki
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | | | - Anna Komosa
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Paweł Uruski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Artur Radziemski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Science, Maria Sklodowska-Curie Medical Academy, Warszawa, Poland
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
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14
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Lin A, van Diemen PA, Motwani M, McElhinney P, Otaki Y, Han D, Kwan A, Tzolos E, Klein E, Kuronuma K, Grodecki K, Shou B, Rios R, Manral N, Cadet S, Danad I, Driessen RS, Berman DS, Nørgaard BL, Slomka PJ, Knaapen P, Dey D. Machine Learning From Quantitative Coronary Computed Tomography Angiography Predicts Fractional Flow Reserve-Defined Ischemia and Impaired Myocardial Blood Flow. Circ Cardiovasc Imaging 2022; 15:e014369. [PMID: 36252116 PMCID: PMC10085569 DOI: 10.1161/circimaging.122.014369] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/13/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND A pathophysiological interplay exists between plaque morphology and coronary physiology. Machine learning (ML) is increasingly being applied to coronary computed tomography angiography (CCTA) for cardiovascular risk stratification. We sought to assess the performance of a ML score integrating CCTA-based quantitative plaque features for predicting vessel-specific ischemia by invasive fractional flow reserve (FFR) and impaired myocardial blood flow (MBF) by positron emission tomography (PET). METHODS This post-hoc analysis of the PACIFIC trial (Prospective Comparison of Cardiac Positron Emission Tomography/Computed Tomography [CT]' Single Photon Emission Computed Tomography/CT Perfusion Imaging and CT Coronary Angiography with Invasive Coronary Angiography) included 208 patients with suspected coronary artery disease who prospectively underwent CCTA' [15O]H2O PET, and invasive FFR. Plaque quantification from CCTA was performed using semiautomated software. An ML algorithm trained on the prospective NXT trial (484 vessels) was used to develop a ML score for the prediction of ischemia (FFR≤0.80), which was then evaluated in 581 vessels from the PACIFIC trial. Thereafter, the ML score was applied for predicting impaired hyperemic MBF (≤2.30 mL/min per g) from corresponding PET scans. The performance of the ML score was compared with CCTA reads and noninvasive FFR derived from CCTA (FFRCT). RESULTS One hundred thirty-nine (23.9%) vessels had FFR-defined ischemia, and 195 (33.6%) vessels had impaired hyperemic MBF. For the prediction of FFR-defined ischemia, the ML score yielded an area under the receiver-operating characteristic curve of 0.92, which was significantly higher than that of visual stenosis grade (0.84; P<0.001) and comparable with that of FFRCT (0.93; P=0.34). Quantitative percent diameter stenosis and low-density noncalcified plaque volume had the greatest ML feature importance for predicting FFR-defined ischemia. When applied for impaired MBF prediction, the ML score exhibited an area under the receiver-operating characteristic curve of 0.80; significantly higher than visual stenosis grade (area under the receiver-operating characteristic curve 0.74; P=0.02) and comparable with FFRCT (area under the receiver-operating characteristic curve 0.77; P=0.16). CONCLUSIONS An externally validated ML score integrating CCTA-based quantitative plaque features accurately predicts FFR-defined ischemia and impaired MBF by PET, performing superiorly to standard CCTA stenosis evaluation and comparably to FFRCT.
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Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pepijn A. van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Manish Motwani
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuka Otaki
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alan Kwan
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Eyal Klein
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keiichiro Kuronuma
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin Shou
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard Rios
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nipun Manral
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S. Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Daniel S. Berman
- Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bjarne L. Nørgaard
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Piotr J. Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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15
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Killekar A, Grodecki K, Lin A, Cadet S, McElhinney P, Razipour A, Chan C, Pressman BD, Julien P, Chen P, Simon J, Maurovich-Horvat P, Gaibazzi N, Thakur U, Mancini E, Agalbato C, Munechika J, Matsumoto H, Menè R, Parati G, Cernigliaro F, Nerlekar N, Torlasco C, Pontone G, Dey D, Slomka P. Rapid quantification of COVID-19 pneumonia burden from computed tomography with convolutional long short-term memory networks. J Med Imaging (Bellingham) 2022; 9:054001. [PMID: 36090960 PMCID: PMC9446878 DOI: 10.1117/1.jmi.9.5.054001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/16/2022] [Indexed: 11/14/2022] Open
Abstract
Purpose: Quantitative lung measures derived from computed tomography (CT) have been demonstrated to improve prognostication in coronavirus disease 2019 (COVID-19) patients but are not part of clinical routine because the required manual segmentation of lung lesions is prohibitively time consuming. We aim to automatically segment ground-glass opacities and high opacities (comprising consolidation and pleural effusion). Approach: We propose a new fully automated deep-learning framework for fast multi-class segmentation of lung lesions in COVID-19 pneumonia from both contrast and non-contrast CT images using convolutional long short-term memory (ConvLSTM) networks. Utilizing the expert annotations, model training was performed using five-fold cross-validation to segment COVID-19 lesions. The performance of the method was evaluated on CT datasets from 197 patients with a positive reverse transcription polymerase chain reaction test result for SARS-CoV-2, 68 unseen test cases, and 695 independent controls. Results: Strong agreement between expert manual and automatic segmentation was obtained for lung lesions with a Dice score of 0.89 ± 0.07 ; excellent correlations of 0.93 and 0.98 for ground-glass opacity (GGO) and high opacity volumes, respectively, were obtained. In the external testing set of 68 patients, we observed a Dice score of 0.89 ± 0.06 as well as excellent correlations of 0.99 and 0.98 for GGO and high opacity volumes, respectively. Computations for a CT scan comprising 120 slices were performed under 3 s on a computer equipped with an NVIDIA TITAN RTX GPU. Diagnostically, the automated quantification of the lung burden % discriminate COVID-19 patients from controls with an area under the receiver operating curve of 0.96 (0.95-0.98). Conclusions: Our method allows for the rapid fully automated quantitative measurement of the pneumonia burden from CT, which can be used to rapidly assess the severity of COVID-19 pneumonia on chest CT.
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Affiliation(s)
- Aditya Killekar
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
| | | | - Andrew Lin
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
| | - Sebastien Cadet
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
| | - Priscilla McElhinney
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
| | - Aryabod Razipour
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
| | - Cato Chan
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
| | - Barry D. Pressman
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
| | - Peter Julien
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
| | - Peter Chen
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
| | | | | | | | - Udit Thakur
- Monash Health, Melbourne, Victoria, Australia
| | | | - Cecilia Agalbato
- University of Milan, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Roberto Menè
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
- University of Milano-Bicocca, Department of Medicine and Surgery, Milan, Italy
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
- University of Milano-Bicocca, Department of Medicine and Surgery, Milan, Italy
| | - Franco Cernigliaro
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
- University of Milano-Bicocca, Department of Medicine and Surgery, Milan, Italy
| | | | - Camilla Torlasco
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
- University of Milano-Bicocca, Department of Medicine and Surgery, Milan, Italy
| | - Gianluca Pontone
- University of Milan, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Damini Dey
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
| | - Piotr Slomka
- Cedars-Sinai Medical Center, Department of Medicine (Division of Artificial Intelligence in Medicine), Biomedical Sciences and Imaging, Los Angeles, California, United States
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16
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Tzolos E, Williams MC, McElhinney P, Lin A, Grodecki K, Flores Tomasino G, Cadet S, Kwiecinski J, Doris M, Adamson PD, Moss AJ, Alam S, Hunter A, Shah ASV, Mills NL, Pawade T, Wang C, Weir-McCall JR, Roditi G, van Beek EJR, Shaw LJ, Nicol ED, Berman DS, Slomka PJ, Dweck MR, Newby DE, Dey D. Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction. JACC Cardiovasc Imaging 2022; 15:1078-1088. [PMID: 35450813 PMCID: PMC9187595 DOI: 10.1016/j.jcmg.2022.02.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [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: 09/07/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pericoronary adipose tissue (PCAT) attenuation and low-attenuation noncalcified plaque (LAP) burden can both predict outcomes. OBJECTIVES This study sought to assess the relative and additive values of PCAT attenuation and LAP to predict future risk of myocardial infarction. METHODS In a post hoc analysis of the multicenter SCOT-HEART (Scottish Computed Tomography of the Heart) trial, the authors investigated the relationships between the future risk of fatal or nonfatal myocardial infarction and PCAT attenuation measured from coronary computed tomography angiography (CTA) using multivariable Cox regression models including plaque burden, obstructive coronary disease, and cardiac risk score (incorporating age, sex, diabetes, smoking, hypertension, hyperlipidemia, and family history). RESULTS In 1,697 evaluable participants (age: 58 ± 10 years), there were 37 myocardial infarctions after a median follow-up of 4.7 years. Mean PCAT was -76 ± 8 HU and median LAP burden was 4.20% (IQR: 0%-6.86%). PCAT attenuation of the right coronary artery (RCA) was predictive of myocardial infarction (HR: 1.55; P = 0.017, per 1 SD increment) with an optimum threshold of -70.5 HU (HR: 2.45; P = 0.01). In multivariable analysis, adding PCAT-RCA of ≥-70.5 HU to an LAP burden of >4% (the optimum threshold for future myocardial infarction; HR: 4.87; P < 0.0001) led to improved prediction of future myocardial infarction (HR: 11.7; P < 0.0001). LAP burden showed higher area under the curve compared to PCAT attenuation for the prediction of myocardial infarction (AUC = 0.71 [95% CI: 0.62-0.80] vs AUC = 0.64 [95% CI: 0.54-0.74]; P < 0.001), with increased area under the curve when the 2 metrics are combined (AUC = 0.75 [95% CI: 0.65-0.85]; P = 0.037). CONCLUSION Coronary CTA-defined LAP burden and PCAT attenuation have marked and complementary predictive value for the risk of fatal or nonfatal myocardial infarction.
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Affiliation(s)
- Evangelos Tzolos
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Priscilla McElhinney
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew Lin
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kajetan Grodecki
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Guadalupe Flores Tomasino
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sebastien Cadet
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jacek Kwiecinski
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Mhairi Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Shirjel Alam
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Amanda Hunter
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Anoop S V Shah
- Department of Non-Communicable Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tania Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chengjia Wang
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonathan R Weir-McCall
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Giles Roditi
- Institute of Clinical Sciences, University of Glasgow, United Kingdom
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Leslee J Shaw
- Icahn School of Medicine, Mount Sinai, New York, USA
| | - Edward D Nicol
- Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Daniel S Berman
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Piotr J Slomka
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Departments of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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17
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Olasińska-Wiśniewska A, Grodecki K, Urbanowicz T, Perek B, Grygier M, Misterski M, Stefaniak S, Mularek-Kubzdela T, Lesiak M, Jemielity M. Pulmonary artery systolic pressure at 1-month predicts 1-year survival after transcatheter aortic valve implantation. Kardiol Pol 2022; 80:825-833. [PMID: 35575408 DOI: 10.33963/kp.a2022.0128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pulmonary hypertension related to left ventricle heart disease is a common finding in patients with severe aortic stenosis treated with transcatheter aortic valve implantation (TAVI) and is associated with a higher mortality rate. AIMS The study aimed to analyze the influence of pulmonary artery systolic pressure (PASP) changes after TAVI on long-term survival. METHODS TAVI was performed in 362 patients between January 2013 and December 2018. The study group comprised 210 patients who underwent a detailed 1-month follow-up. RESULTS At 1-month, 142 had a stable or decreased PASP value (Group 1), while in 68 patients an increase was observed (Group 2). During 1-year follow-up, 20 patients died (9.5%), 9 in Group 1 and 11 in Group 2 (P = 0.02). The receiver operating characteristic (ROC) curve analysis (area under the curve [AUC], 0.750) revealed a significant value of 1-month measurement for 1-year mortality prediction. The cutoff for the PASP value predictive of mortality was ≤41 mm Hg. A Kaplan-Meier analysis showed significantly higher mortality in patients without a 1-month PASP decrease. In the multivariable analysis, PASP measured at 1-month after TAVI (hazard ratio, 1.040; 95% confidence interval, 1.019-1.062; P < 0.001) was an independent predictor of 1-year mortality. Each 1 mm Hg increase in PASP predicts a 4% increase in the risk of death. CONCLUSION Decreased or stable value of PASP at 1-month follow-up may predict better 1-year survival after TAVI, while each 1 mm Hg increase in PASP confers a 4% greater risk of 1-year mortality.
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Affiliation(s)
- Anna Olasińska-Wiśniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland.
| | - Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marcin Misterski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Sebastian Stefaniak
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
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18
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Olasińska-Wiśniewska A, Urbanowicz T, Grodecki K, Perek B, Grygier M, Michalak M, Misterski M, Puślecki M, Rodzki M, Stelmark K, Lesiak M, Jemielity M. Neutrophil-to-lymphocyte ratio as a predictor of inflammatory response in patients with acute kidney injury after transcatheter aortic valve implantation. ADV CLIN EXP MED 2022; 31:937-945. [PMID: 35546564 DOI: 10.17219/acem/149229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Persistent inflammatory response after transcatheter aortic valve implantation (TAVI) is one of the possible causes of early and mid-term postprocedural adverse events. OBJECTIVES To establish the predictive role of whole blood parameters on inflammatory response characteristics within a 1-year follow-up. MATERIAL AND METHODS The study group comprised 163 consecutive patients (52.1% females), mean age 78.6 (±6.6) years (± standard deviation (SD)) who underwent TAVI and completed 1-year follow-up on-site examinations. Patients were retrospectively divided into acute kidney injury (AKI) and non-AKI subgroups. Clinical and laboratory data were collected. In-hospital and follow-up outcomes were assessed. RESULTS The clinical and procedural details did not show significant differences between AKI and non-AKI groups. Neutrophil-to-lymphocyte ratio (NLR) decreased from baseline to measurement after 1 year with a statistically significant decline in the whole study population and non-AKI subgroup (both p = 0.005). The baseline NLR cutoff value of 4.2 for the non-AKI group ((area under the curve (AUC) = 0.718, p < 0.0001; sensitivity 46.27%, specificity 92.31%) and of 3.8 for the AKI group (AUC = 0.673, p = 0.0174; sensitivity 59.25%, specificity 84%) had prognostic properties for persistent NLR elevation. CONCLUSIONS The NLR decreases after TAVI, and this phenomenon is more evident in patients without AKI. Furthermore, baseline NLR cutoff values may be considered predictors of persistence of inflammatory response.
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Affiliation(s)
| | - Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poland
| | - Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poland
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poland
| | - Marcin Misterski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poland
| | - Mateusz Puślecki
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poland
- Department of Medical Rescue, Poznan University of Medical Sciences, Poland
| | - Michał Rodzki
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poland
| | - Konrad Stelmark
- Student Scientific Group, English Division, Poznan University of Medical Sciences, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poland
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19
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Simon J, Grodecki K, Cadet S, Killekar A, Slomka P, Zara SJ, Zsarnóczay E, Nardocci C, Nagy N, Kristóf K, Vásárhelyi B, Müller V, Merkely B, Dey D, Maurovich-Horvat P. Radiomorphological signs and clinical severity of SARS-CoV-2 lineage B.1.1.7. BJR Open 2022; 4:20220016. [PMID: 36452055 PMCID: PMC9667478 DOI: 10.1259/bjro.20220016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/05/2022] Open
Abstract
Objective We aimed to assess the differences in the severity and chest-CT radiomorphological signs of SARS-CoV-2 B.1.1.7 and non-B.1.1.7 variants. Methods We collected clinical data of consecutive patients with laboratory-confirmed COVID-19 and chest-CT imaging who were admitted to the Emergency Department between September 1- November 13, 2020 (non-B.1.1.7 cases) and March 1-March 18, 2021 (B.1.1.7 cases). We also examined the differences in the severity and radiomorphological features associated with COVID-19 pneumonia. Total pneumonia burden (%), mean attenuation of ground-glass opacities and consolidation were quantified using deep-learning research software. Results The final population comprised 500 B.1.1.7 and 500 non-B.1.1.7 cases. Patients with B.1.1.7 infection were younger (58.5 ± 15.6 vs 64.8 ± 17.3; p < .001) and had less comorbidities. Total pneumonia burden was higher in the B.1.1.7 patient group (16.1% [interquartile range (IQR):6.0-34.2%] vs 6.6% [IQR:1.2-18.3%]; p < .001). In the age-specific analysis, in patients <60 years B.1.1.7 pneumonia had increased consolidation burden (0.1% [IQR:0.0-0.7%] vs 0.1% [IQR:0.0-0.2%]; p < .001), and severe COVID-19 was more prevalent (11.5% vs 4.9%; p = .032). Mortality rate was similar in all age groups. Conclusion Despite B.1.1.7 patients were younger and had fewer comorbidities, they experienced more severe disease than non-B.1.1.7 patients, however, the risk of death was the same between the two groups. Advances in knowledge Our study provides data on deep-learning based quantitative lung lesion burden and clinical outcomes of patients infected by B.1.1.7 VOC. Our findings might serve as a model for later investigations, as new variants are emerging across the globe.
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Affiliation(s)
| | | | - Sebastian Cadet
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Aditya Killekar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Piotr Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | | | | | - Chiara Nardocci
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Norbert Nagy
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Katalin Kristóf
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Barna Vásárhelyi
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
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20
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Kwiecinski J, Tzolos E, Fletcher AJ, Nash J, Meah MN, Cadet S, Adamson PD, Grodecki K, Joshi N, Williams MC, van Beek EJR, Lai C, Tavares AAS, MacAskill MG, Dey D, Baker AH, Leipsic J, Berman DS, Sellers SL, Newby DE, Dweck MR, Slomka PJ. Bypass Grafting and Native Coronary Artery Disease Activity. JACC Cardiovasc Imaging 2022; 15:875-887. [PMID: 35216930 PMCID: PMC9246289 DOI: 10.1016/j.jcmg.2021.11.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 07/23/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to describe the potential of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression. BACKGROUND As well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis. METHODS Patients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on 18F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery. RESULTS Among 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting. CONCLUSIONS Native coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.
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Affiliation(s)
- Jacek Kwiecinski
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Evangelos Tzolos
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alexander J Fletcher
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Nash
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mohammed N Meah
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Sebastien Cadet
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Philip D Adamson
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kajetan Grodecki
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nikhil Joshi
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Chi Lai
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adriana A S Tavares
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark G MacAskill
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew H Baker
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonathon Leipsic
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephanie L Sellers
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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21
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Lin A, Manral N, McElhinney P, Killekar A, Matsumoto H, Kwiecinski J, Pieszko K, Razipour A, Grodecki K, Park C, Otaki Y, Doris M, Kwan AC, Han D, Kuronuma K, Flores Tomasino G, Tzolos E, Shanbhag A, Goeller M, Marwan M, Gransar H, Tamarappoo BK, Cadet S, Achenbach S, Nicholls SJ, Wong DT, Berman DS, Dweck M, Newby DE, Williams MC, Slomka PJ, Dey D. Deep learning-enabled coronary CT angiography for plaque and stenosis quantification and cardiac risk prediction: an international multicentre study. Lancet Digit Health 2022; 4:e256-e265. [PMID: 35337643 PMCID: PMC9047317 DOI: 10.1016/s2589-7500(22)00022-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/01/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Atherosclerotic plaque quantification from coronary CT angiography (CCTA) enables accurate assessment of coronary artery disease burden and prognosis. We sought to develop and validate a deep learning system for CCTA-derived measures of plaque volume and stenosis severity. METHODS This international, multicentre study included nine cohorts of patients undergoing CCTA at 11 sites, who were assigned into training and test sets. Data were retrospectively collected on patients with a wide range of clinical presentations of coronary artery disease who underwent CCTA between Nov 18, 2010, and Jan 25, 2019. A novel deep learning convolutional neural network was trained to segment coronary plaque in 921 patients (5045 lesions). The deep learning network was then applied to an independent test set, which included an external validation cohort of 175 patients (1081 lesions) and 50 patients (84 lesions) assessed by intravascular ultrasound within 1 month of CCTA. We evaluated the prognostic value of deep learning-based plaque measurements for fatal or non-fatal myocardial infarction (our primary outcome) in 1611 patients from the prospective SCOT-HEART trial, assessed as dichotomous variables using multivariable Cox regression analysis, with adjustment for the ASSIGN clinical risk score. FINDINGS In the overall test set, there was excellent or good agreement, respectively, between deep learning and expert reader measurements of total plaque volume (intraclass correlation coefficient [ICC] 0·964) and percent diameter stenosis (ICC 0·879; both p<0·0001). When compared with intravascular ultrasound, there was excellent agreement for deep learning total plaque volume (ICC 0·949) and minimal luminal area (ICC 0·904). The mean per-patient deep learning plaque analysis time was 5·65 s (SD 1·87) versus 25·66 min (6·79) taken by experts. Over a median follow-up of 4·7 years (IQR 4·0-5·7), myocardial infarction occurred in 41 (2·5%) of 1611 patients from the SCOT-HEART trial. A deep learning-based total plaque volume of 238·5 mm3 or higher was associated with an increased risk of myocardial infarction (hazard ratio [HR] 5·36, 95% CI 1·70-16·86; p=0·0042) after adjustment for the presence of deep learning-based obstructive stenosis (HR 2·49, 1·07-5·50; p=0·0089) and the ASSIGN clinical risk score (HR 1·01, 0·99-1·04; p=0·35). INTERPRETATION Our novel, externally validated deep learning system provides rapid measurements of plaque volume and stenosis severity from CCTA that agree closely with expert readers and intravascular ultrasound, and could have prognostic value for future myocardial infarction. FUNDING National Heart, Lung, and Blood Institute and the Miriam & Sheldon G Adelson Medical Research Foundation.
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Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia; MonashHeart, Monash Health, Melbourne, VIC, Australia
| | - Nipun Manral
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aditya Killekar
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Jacek Kwiecinski
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Konrad Pieszko
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Interventional Cardiology, Collegium Medicum, University of Zielona Góra, Poland
| | - Aryabod Razipour
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Caroline Park
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuka Otaki
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mhairi Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Alan C Kwan
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keiichiro Kuronuma
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Guadalupe Flores Tomasino
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Evangelos Tzolos
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Aakash Shanbhag
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Markus Goeller
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Balaji K Tamarappoo
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia; MonashHeart, Monash Health, Melbourne, VIC, Australia
| | - Dennis T Wong
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia; MonashHeart, Monash Health, Melbourne, VIC, Australia
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marc Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Piotr J Slomka
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Kuronuma K, Van Diemen P, Han D, Lin A, McElhinney P, Tomasino GF, Park C, Otaki Y, Kwan A, Tzolos E, Klein E, Grodecki K, Shou B, Rios R, Manral N, Cadet S, Danad I, Driessen R, Berman DS, Slomka P, Dey D, Knaapen P. ASSOCIATION BETWEEN VASCULAR INFLAMMATION BY PERICORONARY ADIPOSETISSUE ATTENUATION FROM CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY AND MYOCARDIAL BLOOD FLOW USING POSITRON EMISSION TOMOGRAPHY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02210-0] [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: 11/26/2022]
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23
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Grodecki K, Huczek Z, Lin A, Protasiewicz M, Walczak A, Dariusz J, Grygier M, Kochman J, Wojakowski W, Dey D. SEX-SPECIFIC DIFFERENCES IN AORTIC VALVE COMPOSITION QUANTIFIED FROM COMPUTED TOMOGRAPHY ANGIOGRAPHY IN SEVERE AORTIC STENOSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02231-8] [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: 11/25/2022]
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24
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Lin A, Manral N, McElhinney P, Killekar A, Matsumoto H, Kwiecinski J, Pieszko K, Grodecki K, Otaki Y, Han D, Tzolos E, Shanbhag A, Goeller M, Marwan M, Gransar H, Cadet S, Achenbach S, Nicholls SJ, Wong DTL, Berman DS, Dweck M, Newby DE, Williams MC, Slomka P, Dey D. DEEP LEARNING FROM CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY FOR ATHEROSCLEROTIC PLAQUE AND STENOSIS QUANTIFICATION AND CARDIAC RISK PREDICTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04474-6] [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: 10/18/2022]
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25
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Han D, Van Diemen P, Kuronuma K, Lin A, McElhinney P, Tomasino GF, Park C, Otaki Y, Kwan A, Tzolos E, Klein E, Grodecki K, Shou B, Rios R, Manral N, Cadet S, Danad I, Driessen R, Berman DS, Slomka P, Dey D, Knaapen P. SEX DIFFERENCES IN QUANTITATIVE COMPUTED TOMOGRAPHY CORONARY PLAQUE CHARACTERIZATION AND FRACTIONAL FLOW RESERVE: SUBSTUDY OF THE PACIFIC TRIAL. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02202-1] [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: 10/18/2022]
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26
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Kwiecinski J, Tzolos E, Meah MN, Cadet S, Adamson PD, Grodecki K, Joshi NV, Moss AJ, Williams MC, van Beek EJR, Berman DS, Newby DE, Dey D, Dweck MR, Slomka PJ. Machine Learning with 18F-Sodium Fluoride PET and Quantitative Plaque Analysis on CT Angiography for the Future Risk of Myocardial Infarction. J Nucl Med 2022; 63:158-165. [PMID: 33893193 PMCID: PMC8717197 DOI: 10.2967/jnumed.121.262283] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
Coronary 18F-sodium fluoride (18F-NaF) PET and CT angiography-based quantitative plaque analysis have shown promise in refining risk stratification in patients with coronary artery disease. We combined both of these novel imaging approaches to develop an optimal machine-learning model for the future risk of myocardial infarction in patients with stable coronary disease. Methods: Patients with known coronary artery disease underwent coronary 18F-NaF PET and CT angiography on a hybrid PET/CT scanner. Machine-learning by extreme gradient boosting was trained using clinical data, CT quantitative plaque analysis, measures and 18F-NaF PET, and it was tested using repeated 10-fold hold-out testing. Results: Among 293 study participants (65 ± 9 y; 84% male), 22 subjects experienced a myocardial infarction over the 53 (40-59) months of follow-up. On univariable receiver-operator-curve analysis, only 18F-NaF coronary uptake emerged as a predictor of myocardial infarction (c-statistic 0.76, 95% CI 0.68-0.83). When incorporated into machine-learning models, clinical characteristics showed limited predictive performance (c-statistic 0.64, 95% CI 0.53-0.76) and were outperformed by a quantitative plaque analysis-based machine-learning model (c-statistic 0.72, 95% CI 0.60-0.84). After inclusion of all available data (clinical, quantitative plaque and 18F-NaF PET), we achieved a substantial improvement (P = 0.008 versus 18F-NaF PET alone) in the model performance (c-statistic 0.85, 95% CI 0.79-0.91). Conclusion: Both 18F-NaF uptake and quantitative plaque analysis measures are additive and strong predictors of outcome in patients with established coronary artery disease. Optimal risk stratification can be achieved by combining clinical data with these approaches in a machine-learning model.
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Affiliation(s)
- Jacek Kwiecinski
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Evangelos Tzolos
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Mohammed N Meah
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Sebastien Cadet
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Philip D Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Kajetan Grodecki
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nikhil V Joshi
- Bristol Heart Institute, University of Bristol, United Kingdom; and
| | - Alastair J Moss
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Edwin J R van Beek
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Daniel S Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Damini Dey
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California;
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27
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Jędrzejczyk S, Rymuza B, Ścisło P, Grodecki K, Pędzich-Placha E, Grabowski M, Kochman J, Huczek Z. Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) in valve-in-valve Transcatheter Aortic Valve Implantation (ViV-TAVI): First experience in Poland. Kardiol Pol 2022; 80:1266-1267. [PMID: 36161589 DOI: 10.33963/kp.a2022.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Szymon Jędrzejczyk
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland.
| | - Bartosz Rymuza
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Piotr Ścisło
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Kajetan Grodecki
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Ewa Pędzich-Placha
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Janusz Kochman
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Zenon Huczek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
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28
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Huczek Z, Jędrzejczyk S, Jagielak D, Dąbrowski M, Grygier M, Gruz-Kwapisz M, Fil W, Olszówka P, Frank M, Wilczek K, Walczak A, Trębacz J, Telichowski A, Protasiewicz M, Sacha J, Rymuza B, Grodecki K, Scisło P, Hudziak D, Gocoł R, Zembala M, Wilimski R, Kochman J, Witkowski A, Wojakowski W. Transcatheter aortic valve-in-valve implantation for failed surgical bioprostheses: results from Polish Transcatheter Aortic Valve-in-Valve Implantation (ViV-TAVI) Registry. Pol Arch Intern Med 2021; 132. [PMID: 34845900 DOI: 10.20452/pamw.16149] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Transcatheter aortic valve-in-valve implantation (ViV-TAVI) emerged recently as an alternative to re-do surgery for patients with failed surgical aortic valve (SAV). OBJECTIVES To evaluate the safety and efficacy of transcatheter aortic valves (TAV) in failed SAV in Poland. PATIENTS AND METHODS Data was acquired using a nationwide, multicenter (n=14) Polish Transcatheter Aortic Valve-in-Valve Implantation (ViV-TAVI) Registry (ClinicalTrials.gov Identifier, NCT03361046) with online form collection and 1-year follow-up. RESULTS ViV-TAVI procedures (n=130) constituted 1.9% of all TAVI in Poland with increasing numbers since 2018 (n=59, 45% of all). Hancock II® (21%), Freestyle® (13%), and homograft (11.5%) were identified as the most frequently treated SAV's with self-expanding, supra-annular Corevalve/Evolut® TAV used in the majority of cases (76%). Average post-procedural pressure gradient (average PG) >20 mmHg was found in 21% and 1-year all-cause mortality was 10.8%. SAV stenosis compared to regurgitation/mixed disease was associated with higher average (16, IQR 13.5 - 22.5 vs 14.5, IQR 10-19 mmHg, p=0.004) whereas implantation of supra-annular TAV resulted in lower average PG (14, IQR 10.5-20 vs. intra-annular 19, IQR 16-26 mmHg, P=0.004). After introduction of 2nd generation TAV, shorter procedure time (120, IQR 80-165 min. vs. 135, IQR 108-200 min., P=0.04), less frequent need for additional TAV (2% vs. 10%, P=0.04) and better 1-year freedrom from cardiovascular deaths (95% vs. 82.8%, hazard ratio 0.25, 95% confidence intervals 0.17-0.88, P=0.03) was observed vs. 1st generation. CONCLUSIONS Transcatheter treatment of failed SAV is becoming more frequent, showing the best hemodynamic effect with the use of supra-annular TAV and improved procedural as well as clinical results with the introduction of 2nd generation TAV.
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Affiliation(s)
- Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Szymon Jędrzejczyk
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Monika Gruz-Kwapisz
- 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Fil
- Polish-American Heart Clinic, Bielsko-Biała, Poland
| | - Piotr Olszówka
- Department of Cardiac Surgery, District Hospital No. 2, Rzeszów, Poland
| | - Marek Frank
- Department of Cardiac Surgery, Medical University of Bialystok, Białystok, Poland
| | - Krzysztof Wilczek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Andrzej Walczak
- Department of Cardiac Surgery, Medical University of Lodz, Łódź, Poland
| | - Jarosław Trębacz
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Artur Telichowski
- Department of Anesthesiology and Intensive Therapy, 4th Military Hospital, Wrocław, Poland
| | | | - Jerzy Sacha
- Department of Cardiology, University Hospital in Opole, Opole, Poland
| | - Bartosz Rymuza
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Scisło
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Damian Hudziak
- 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Radosław Gocoł
- 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Michał Zembala
- Department of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Wojciech Wojakowski
- 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland
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29
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Tzolos E, Williams MC, McElhinney P, Lin A, Grodecki K, Guadalupe FT, Cadet S, Berman DS, Slomka PJ, Dweck MR, Newby DE, Dey DE. Pericoronary adipose tissue attenuation, low-attenuation plaque burden and 5-year risk of myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0156] [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
Introduction
Pericoronary adipose tissue (PCAT) attenuation has emerged as a surrogate marker of pericoronary inflammation. To date, no studies have compared the impact of pericoronary adipose tissue (PCAT) attenuation and quantitative plaque burden on cardiac outcomes.
Purpose
We aimed to establish the relative merits of these approaches to risk prediction and hypothesised that the combination of PCAT attenuation and quantitative plaque burden measures could provide additive and improved prediction of myocardial infarction in patients with stable chest pain.
Methods
In a post-hoc analysis of a randomized controlled trial, we investigated the association between the future risk of fatal or non-fatal myocardial infarction and PCAT attenuation measured from CT coronary angiography using multivariable Cox regression models including plaque burden, obstructive coronary disease and cardiac risk score (incorporating age, sex, diabetes, smoking, hypertension, hyperlipidaemia and family history of cardiovascular disease).
Results
In 1697 evaluable participants (mean age 58±10 years), there were 37 myocardial infarctions after a median follow-up of 4.7 [interquartile interval, 4.0–5.7] years. Median low-attenuation plaque burden was 4.20 [0–6.86] % and mean PCAT −76±8 Hounsfield units (HU).
PCAT attenuation of the right coronary artery (RCA) was predictive of myocardial infarction (hazard ratio [HR] 1.55, 95% CI 1.08–2.22; p=0.017, per 1 standard deviation increment) with an optimum threshold of −70.5 HU [Hazards ratio (HR) 2.45, 95% CI 1.2–4.9; p=0.01]. Univariable analysis also identified the burden of non-calcified, low-attenuation and calcified plaque as well as Agatston coronary calcium score, presence of obstructive coronary artery disease and cardiovascular risk score were predictors of myocardial infarction (Figure 1). In multivariable analysis, only the low-attenuation plaque burden (HR 1.80, 95% CI 1.16 to 2.81, p=0.011, per doubling) and PCAT-RCA (HR 1.47 95%1.02 to 2.13, p=0.040, per standard deviation increment) remained predictors of myocardial infarction (Figure 1).
In multivariable analysis, adding PCAT-RCA ≥-70.5 HU to low-attenuation plaque burden >4% (optimum threshold for future myocardial infarction; HR = 4.87, 95% CI 2.03–11.78; p<0.0001) led to improved prediction of future myocardial infarction (HR 11.7, 95% CI 3.3–40.9; p<0.0001); Figure 2. In ROC analysis, integration of PCAT-RCA attenuation and LAP burden, increased the prediction for myocardial infarction compared to LAP alone (ΔAUC=0.04; p=0.01).
Conclusion
CT coronary angiography defined PCAT attenuation and low-attenuation plaque have marked and additive predictive value for the risk of fatal or non-fatal myocardial infarction.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Chief Scientist Office of the Scottish Government Health and Social Care Directorates, British Heart Foundation, National Institute of Health/National Heart, Lung, and Blood Institute grant
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Affiliation(s)
- E Tzolos
- University of Edinburgh, Edinburgh, United Kingdom
| | - M C Williams
- University of Edinburgh, Edinburgh, United Kingdom
| | - P McElhinney
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Los Angeles, United States of America
| | - A Lin
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Los Angeles, United States of America
| | - K Grodecki
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Los Angeles, United States of America
| | - F T Guadalupe
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Los Angeles, United States of America
| | - S Cadet
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Los Angeles, United States of America
| | - D S Berman
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Los Angeles, United States of America
| | - P J Slomka
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Los Angeles, United States of America
| | - M R Dweck
- University of Edinburgh, Edinburgh, United Kingdom
| | - D E Newby
- University of Edinburgh, Edinburgh, United Kingdom
| | - D E Dey
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Los Angeles, United States of America
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Grodecki K, Tamarappoo BK, Huczek Z, Jedrzejczyk S, Cadet S, Kwiecinski J, Rymuza B, Parma R, Olasinska-Wisniewska A, Fijalkowska J, Protasiewicz M, Walczak A, Nowak A, Gocol R, Slomka PJ, Reczuch K, Jagielak D, Grygier M, Wojakowski W, Filipiak KJ, Dey D. Non-calcific aortic tissue quantified from computed tomography angiography improves diagnosis and prognostication of patients referred for transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2021; 22:626-635. [PMID: 33247903 DOI: 10.1093/ehjci/jeaa304] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/15/2020] [Accepted: 10/22/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS We aimed to investigate the role of aortic valve tissue composition from quantitative cardiac computed tomography angiography (CTA) in patients with severe aortic stenosis (AS) for the differentiation of disease subtypes and prognostication after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS Our study included 447 consecutive AS patients from six high-volume centres reporting to a prospective nationwide registry of TAVI procedures (POL-TAVI), who underwent cardiac CTA before TAVI, and 224 matched controls with normal aortic valves. Components of aortic valve tissue were identified using semi-automated software as calcific and non-calcific. Volumes of each tissue component and composition [(tissue component volume/total tissue volume) × 100%] were quantified. Relationship of aortic valve composition with clinical outcomes post-TAVI was evaluated using Valve Academic Research Consortium (VARC)-2 definitions.High-gradient (HG) AS patients had significantly higher aortic tissue volume compared to low-flow low-gradient (LFLG)-AS (1672.7 vs. 1395.3 mm3, P < 0.001) as well as controls (509.9 mm3, P < 0.001), but increased non-calcific tissue was observed in LFLG compared to HG patients (1063.6 vs. 860.2 mm3, P < 0.001). Predictive value of aortic valve calcium score [area under the curve (AUC) 0.989, 95% confidence interval (CI): 0.981-0.996] for severe AS was improved after addition of non-calcific tissue volume (AUC 0.995, 95% CI: 0.991-0.999, P = 0.011). In the multivariable analysis of clinical and quantitative computed tomography parameters of aortic valve tissue, non-calcific tissue volume [odds ratio (OR) 5.2, 95% CI 1.8-15.4, P = 0.003] and history of stroke (OR 2.6, 95% CI 1.1-6.5, P = 0.037) were independent predictors of 30-day major adverse cardiovascular event (MACE). CONCLUSION Quantitative CTA assessment of aortic valve tissue volume and composition can improve detection of severe AS, differentiation between HG and LFLG-AS in patients referred for TAVI as well as prediction of 30-day MACEs post-TAVI, over the current clinical standard.
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Affiliation(s)
- Kajetan Grodecki
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA.,1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | | | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Szymon Jedrzejczyk
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Sebastien Cadet
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42 04-628 Warsaw, Poland
| | - Bartosz Rymuza
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Anna Olasinska-Wisniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Długa 1/2, 61-848 Poznan, Poland
| | - Jadwiga Fijalkowska
- 2nd Department of Radiology, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 - Gdansk, Poland
| | - Marcin Protasiewicz
- Department of Cardiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Andrzej Walczak
- Department of Cardiac Surgery, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland
| | - Adrianna Nowak
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Radoslaw Gocol
- Department of Cardiac Surgery, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Piotr J Slomka
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
| | - Krzysztof Reczuch
- Department of Cardiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Dariusz Jagielak
- Department of Cardiac Surgery, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 - Gdansk, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2, 61-848 Poznan, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Krzysztof J Filipiak
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
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Zbroński K, Grodecki K, Gozdowska R, Ostrowska E, Wysińska J, Rymuza B, Scisło P, Wilimski R, Kochman J, Filipiak KJ, Opolski G, Huczek Z. Protamine sulfate during transcatheter aortic valve implantation (PS TAVI) - a single-center, single-blind, randomized placebo-controlled trial. Kardiol Pol 2021; 79:995-1002. [PMID: 34292562 DOI: 10.33963/kp.a2021.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bleeding complications after transcatheter aortic valve implantation (TAVI) negatively affect the post-procedural prognosis. Routine use of protamine sulfate (PS) to reverse unfractionated heparin after TAVI was never assessed in a randomized controlled trial. AIMS The aim of this study was to assess the impact of PS on bleeding complications after TAVI. METHODS Between December 2016 and July 2020 311 patients qualified to TAVI in one academic center were screened. Patients that met the inclusion criteria were randomized to either PS or normal saline administration at the moment of optimal valve deployment. Baseline, procedural and follow-up data up to 30 days were collected and analyzed. The primary endpoint (PE) was a composite of life-threatening and major bleeding according to Valve Academic Research Consortium within 48 hours after the procedure. RESULTS Overall, 100 patients (48 males, median age 82 years) met the inclusion criteria and were included in the study. Forty-seven subjects (47%) were randomized to PS. The primary endpoint occurred in the 29% of the study population. Despite a numerically lower rates of PE in patients randomized to PS, a statistical significance was not reached (21% in the PS group and 36% in the placebo group; odds ratio [OR], 0.48; 95% confidence intervals [CI] 0.2-1.2; P = 0.11). There were no significant differences in secondary endpoints. CONCLUSIONS Routine protamine sulfate administration did not significantly decrease the rate of major and life-threatening bleeding complications after TAVI. Larger studies are required to assess the impact of routine PS use.
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Affiliation(s)
- Karol Zbroński
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland.
| | - Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Roksana Gozdowska
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Ewa Ostrowska
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Julia Wysińska
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Bartosz Rymuza
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Piotr Scisło
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Warszawa, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | | | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
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Lin A, van Diemen P, Motwani M, McElhinney P, Otaki Y, Han D, Kwan A, Tzolos E, Klein E, Kuronuma K, Grodecki K, Shou B, Cadet S, Danad I, Driessen R, Slomka P, Berman D, Dey D, Knaapen P. Machine Learning From Quantitative Coronary Computed Tomography Angiography Predicts Ischemia And Impaired Myocardial Blood Flow. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tzolos E, Williams M, McElhinney P, Lin A, Grodecki K, Guadalupe F, Cadet S, Kwiecinski J, Doris M, Adamson P, Moss A, Alam S, Hunter A, Shah A, Mills N, Pawade T, Wang C, Weir-McCall J, Roditi G, van Beek E, Shaw L, Nicol E, Berman D, Slomka P, Dweck M, Newby D, Dey D. Pericoronary Adipose Tissue Attenuation, Low Attenuation Plaque Burden And 5-year Risk Of Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.198] [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: 11/27/2022]
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Huczek Z, Rymuza B, Mazurek M, Wilimski R, Scisło P, Zbroński K, Grodecki K, Jędrzejczyk S, Pędzich-Placha E, Hendzel P, Filipiak KJ, Opolski G, Kochman J. Temporal trends of transcatheter aortic valve implantation in high-volume academic center over 10 years. Kardiol Pol 2021; 79:820-826. [PMID: 34076883 DOI: 10.33963/kp.a2021.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Indications for transcatheter aortic valve implantation (TAVI) have gradually expanded since its introduction. AIM The aim was to analyze temporal trends in TAVI characteristics based on experience of high-volume academic center over the period of 10 years. METHODS Five hundred and six consecutive (n = 506) patients with 1-year follow-up were divided into early (G1, years 2010-2013, n = 130), intermediate (G2, 2014-2016, n = 164) and recent (G3, 2017-2019, n = 212) experience groups. RESULTS Patient's age remained constant over time (mean [SD]; G1 = 79.1 [7.1] years vs G2 = 79.1 [7.1] years vs G3 = 79.7 [6.6] years, P = 0.73) but surgical risk in G3 was lower (log Euroscore, median [IQR]: G1 = 14.0 [8.4-20.2] vs G2 = 12.0 [7.0-22.2] vs G3 = 5.1 [3.5-8.5], P < 0.001). Major/life-threatening bleeding (G1 = 26.9% vs G2 = 12.8% vs G3 = 9.4%; P < 0.001), major vascular complications (G1 = 15.4% vs G2 = 8.5% vs G3 = 5.7%; P = 0.02) and moderate/severe paravalvular leak (G1 = 16.2% vs G2 = 11% vs G3 = 7.5%; P = 0.046) were decreasing with time. There was a significant drop in all-cause 1-year mortality in G3 (G1 = 20% vs G2 = 17.7% vs G3 = 9.1%; log rank = 0.01). CONCLUSION Age of TAVI recipients remained unchanged over the last decade. Decreasing surgical risk coupled with improvements in procedural technique and care resulted in fewer periprocedural complications and better 1-year survival.
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Affiliation(s)
- Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Bartosz Rymuza
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Maciej Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Radosław Wilimski
- Department of Cardiosurgery, Medical University of Warsaw, Warszawa, Poland
| | - Piotr Scisło
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Karol Zbroński
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Kajetan Grodecki
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Szymon Jędrzejczyk
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Ewa Pędzich-Placha
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Piotr Hendzel
- Department of Cardiosurgery, Medical University of Warsaw, Warszawa, Poland
| | | | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
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Tzolos E, Williams M, McElhinney P, Lin A, Grodecki K, Guadalupe FT, Cadet S, Kwiecinski J, Doris M, Adamson PD, Moss AJ, Alam S, Hunter A, Shah ASV, Mills NL, Pawade T, Wang C, Weir-McCall JR, Roditi G, van Beek E, Shaw L, Nicol ED, Berman DS, Slomka P, Dweck M, Newby D, Dey D. 155 Pericoronary adipose tissue attenuation, low attenuation plaque burden and 5-year risk of myocardial infarction. Imaging 2021. [DOI: 10.1136/heartjnl-2021-bcs.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: 11/04/2022] Open
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Lin A, Van Diemen P, Motwani M, McElhinney P, Otaki Y, Kwan A, Han D, Kuronuma K, Klein E, Grodecki K, Shou B, Cadet S, Danad I, Driessen R, Slomka P, Berman D, Dey D, Knaapen P. MACHINE LEARNING ISCHEMIA RISK SCORE FROM CORONARY CT ANGIOGRAPHY PREDICTS LESION-SPECIFIC ISCHEMIA AND IMPAIRED MYOCARDIAL BLOOD FLOW: RESULTS FROM THE PACIFIC TRIAL. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02627-9] [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: 10/21/2022]
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Grodecki K, Killekar A, Lin A, Cadet S, McElhinney P, Razipour A, Chan C, Pressman BD, Julien P, Simon J, Maurovich-Horvat P, Gaibazzi N, Thakur U, Mancini E, Agalbato C, Munechika J, Matsumoto H, Menè R, Parati G, Cernigliaro F, Nerlekar N, Torlasco C, Pontone G, Dey D, Slomka PJ. Rapid quantification of COVID-19 pneumonia burden from computed tomography with convolutional LSTM networks. ArXiv 2021:arXiv:2104.00138v3. [PMID: 33821209 PMCID: PMC8020980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 07/17/2021] [Indexed: 11/19/2022]
Abstract
Quantitative lung measures derived from computed tomography (CT) have been demonstrated to improve prognostication in Coronavirus disease 2019 (COVID-19) patients, but are not part of the clinical routine since required manual segmentation of lung lesions is prohibitively time-consuming. We propose a new fully automated deep learning framework for quantification and differentiation between lung lesions in COVID-19 pneumonia from both contrast and non-contrast CT images using convolutional Long Short-Term Memory (LSTM) networks. Utilizing the expert annotations, model training was performed using 5-fold cross-validation to segment ground-glass opacity and high opacity (including consolidation and pleural effusion). The performance of the method was evaluated on CT data sets from 197 patients with positive reverse transcription polymerase chain reaction test result for SARS-CoV-2. Strong agreement between expert manual and automatic segmentation was obtained for lung lesions with a Dice score coefficient of 0.876 ± 0.005; excellent correlations of 0.978 and 0.981 for ground-glass opacity and high opacity volumes. In the external validation set of 67 patients, there was dice score coefficient of 0.767 ± 0.009 as well as excellent correlations of 0.989 and 0.996 for ground-glass opacity and high opacity volumes. Computations for a CT scan comprising 120 slices were performed under 2 seconds on a personal computer equipped with NVIDIA Titan RTX graphics processing unit. Therefore, our deep learning-based method allows rapid fully-automated quantitative measurement of pneumonia burden from CT and may generate the big data with an accuracy similar to the expert readers.
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Affiliation(s)
- Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aditya Killekar
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Priscilla McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aryabod Razipour
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cato Chan
- Department of Imaging, Cedars-Sinai Medical Center, USA
| | | | - Peter Julien
- Department of Imaging, Cedars-Sinai Medical Center, USA
| | - Judit Simon
- Department of Radiology, Semmelweis University, Budapest, Hungary
| | | | - Nicola Gaibazzi
- Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | | | | | - Jiro Munechika
- Division of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Roberto Menè
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Franco Cernigliaro
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy
| | | | - Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy
| | | | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J. Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Grodecki K, Lin A, Razipour A, Cadet S, McElhinney PA, Chan C, Pressman BD, Julien P, Maurovich-Horvat P, Gaibazzi N, Thakur U, Mancini E, Agalbato C, Menè R, Parati G, Cernigliaro F, Nerlekar N, Torlasco C, Pontone G, Slomka PJ, Dey D. Epicardial adipose tissue is associated with extent of pneumonia and adverse outcomes in patients with COVID-19. Metabolism 2021; 115:154436. [PMID: 33221381 PMCID: PMC7676319 DOI: 10.1016/j.metabol.2020.154436] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/21/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
AIM We sought to examine the association of epicardial adipose tissue (EAT) quantified on chest computed tomography (CT) with the extent of pneumonia and adverse outcomes in patients with coronavirus disease 2019 (COVID-19). METHODS We performed a post-hoc analysis of a prospective international registry comprising 109 consecutive patients (age 64 ± 16 years; 62% male) with laboratory-confirmed COVID-19 and noncontrast chest CT imaging. Using semi-automated software, we quantified the burden (%) of lung abnormalities associated with COVID-19 pneumonia. EAT volume (mL) and attenuation (Hounsfield units) were measured using deep learning software. The primary outcome was clinical deterioration (intensive care unit admission, invasive mechanical ventilation, or vasopressor therapy) or in-hospital death. RESULTS In multivariable linear regression analysis adjusted for patient comorbidities, the total burden of COVID-19 pneumonia was associated with EAT volume (β = 10.6, p = 0.005) and EAT attenuation (β = 5.2, p = 0.004). EAT volume correlated with serum levels of lactate dehydrogenase (r = 0.361, p = 0.001) and C-reactive protein (r = 0.450, p < 0.001). Clinical deterioration or death occurred in 23 (21.1%) patients at a median of 3 days (IQR 1-13 days) following the chest CT. In multivariable logistic regression analysis, EAT volume (OR 5.1 [95% CI 1.8-14.1] per doubling p = 0.011) and EAT attenuation (OR 3.4 [95% CI 1.5-7.5] per 5 Hounsfield unit increase, p = 0.003) were independent predictors of clinical deterioration or death, as was total pneumonia burden (OR 2.5, 95% CI 1.4-4.6, p = 0.002), chronic lung disease (OR 1.3 [95% CI 1.1-1.7], p = 0.011), and history of heart failure (OR 3.5 [95% 1.1-8.2], p = 0.037). CONCLUSIONS EAT measures quantified from chest CT are independently associated with extent of pneumonia and adverse outcomes in patients with COVID-19, lending support to their use in clinical risk stratification.
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Affiliation(s)
- Kajetan Grodecki
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Monash Health, Melbourne, Australia
| | - Aryabod Razipour
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Priscilla A McElhinney
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cato Chan
- Department of Imaging, Cedars-Sinai Medical Center, USA
| | | | - Peter Julien
- Department of Imaging, Cedars-Sinai Medical Center, USA
| | | | - Nicola Gaibazzi
- Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | | | | | - Robert Menè
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Franco Cernigliaro
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy
| | | | - Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy
| | | | - Piotr J Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Scisło P, Grodecki K, Rymuza B, Zbroński K, Kochman J, Wilimski R, Huczek Z. Impact of transcatheter aortic valve implantation on coexistent mitral regurgitation parameters. Kardiol Pol 2020; 79:179-184. [PMID: 33198449 DOI: 10.33963/kp.15680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Data on the impact of transcatheter aortic valve implantation (TAVI) on coexisting mitral regurgitation (MR) are still inconsistent. AIMS The study aimed to evaluate the impact of TAVI on coexistent MR depending on its etiology. METHODS Out of 311 patients treated with TAVI, we selected 48 with coexistent MR: functional (FMR; n = 26) or nonfunctional (nFMR; n = 22). The impact of the procedure on MR was quantitatively assessed during a 1‑year follow‑up using MR effective regurgitant orifice area (MR‑EROA) and volume (MRV). RESULTS Compared with baseline, no change of MR‑EROA was observed at 1‑year follow‑up in all patients with MR (median [interquartile range (IQR)], 0.2 [0.17-0.23]cm2 vs 0.17 [0.14-0.2]cm2 ; P = 0.054). No change in MR‑EROA was also noted either in FMR (median [IQR], 0.21 [0.17-0.27]cm2 vs 0.19 [0.14-0.25]cm2 ; P = 0.142) or nFMR (median [IQR], 0.17 [0.12-0.23] cm2 vs 0.17 [0.1-0.2] cm2 ; P = 0.238) cohorts. Decreased MRV was seen in theoverall MR population after TAVI (median [IQR], 32 [28-36]ml/beat vs 26 [22-28]ml/beat; P = 0.002). Similarly, decreased MRV was noted in both FMR (median [IQR], 33 [26-42] ml/beat vs 26 [20-40] ml/beat; P = 0.042) and nFMR (median [IQR], 30 [20-46] ml/beat vs 24 [15-33] ml/beat; P = 0.015) cohorts. CONCLUSIONS Transcatheter aortic valve implantation had no impact on MR‑EROA regardless of the etiology of regurgitation. However, the procedure reduced MRV in both FMR and nFMR.
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Grodecki K, Tamarappoo B, Huczek Z, Jedrzejczyk S, Cadet S, Kwiecinski J, Slomka P, Rymuza B, Filipiak K, Dey D. Non-invasive quantitative characterization of aortic valve tissue composition from computed tomography angiography improves patient risk stratification in transcatheter aortic valve implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0165] [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
Background
Computed tomography angiography (CTA) performed for procedural planning of transcatheter aortic valve implantation (TAVI) can be used for a more complete characterization of aortic valve tissue beyond calcium assessment. Combining quantitative data on both noncalcified and calcified tissues may improve differentiation of aortic stenosis (AS) subtypes and prognostication post-TAVI.
Purpose
We sought to noninvasively assess aortic valve tissue composition with quantitative cardiac CTA in patients with AS and its prognostic vaalue in those who underwent TAVI.
Methods
In 185 consecutive AS patients in a prospective registry who underwent cardiac CTA before TAVR and 90 matched controls with normal aortic valves, non-luminal aortic valve tissue were identified using semi-automated software as non-calcified (low-attenuation [−30 to 30 Hounsfield Units (HU)], fibro-fatty (31 to 130 HU), fibrous (131 to 350 HU) and calcified (>650 HU) tissue; with total tissue as (non-calcified + calcified components). Volumes of each component and composition [(tissue component volume/total tissue volume) ×100%] were quantified. The association of aortic valve composition and clinical outcomes post-TAVI including all-cause mortality was evaluated using Valve Academic Research Consortium (VARC)-2 definitions.
Results
AS patients had greater aortic valve tissue volume (median 2000.2, vs 527.8 mm3, p<0.001) with a higher calcified tissue composition (41.8% vs 3.4%, p<0.001) compared to controls. Total aortic valve tissue (noncalcified and calcified) volume yielded the highest area under the operating curve (AUC) for diagnosing severe AS (0.93,95% CI:0.93–0.99) as compared to calcified tissue volume alone (0.87,95% CI:0.81–0.94, p=0.002). Low-flow low-gradient AS was associated with increase in total tissue volume compared to controls (1515.3 vs 527.8 mm3, p<0.001), with lower volumes of calcified tissue than high-gradient AS (412.5 vs 829.6 mm3, p<0.001). Device success was achieved in 88% (164 of 185) patients and prevalence of moderate or severe paravalvular leak was 3.8%, however no differences between in aortic valve composition were observed in patients with and without device success. Early safety endpoints occurred in 16.1% (29 of 180) patients and 30-day all-cause mortality was 4.4%. Whereas only calcified tissue volume was related to VARC-2 early safety, AUC for prediction of 30-day mortality post-TAVI was 0.793 (95% CI:0.685–0.901) for total tissue volume and 0.776 (95% CI:0.676–0.876) for calcified tissue volume.
Conclusions
Quantitative CTA assessment of aortic valve tissue volume and composition can improve identification of high-gradient AS and low-flow low-gradient AS patients referred for TAVI and predict 30-day mortality post-TAVI.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute (NHLBI)
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Affiliation(s)
- K Grodecki
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Department of Biomedical Sciences, Los Angeles, United States of America
| | - B.K Tamarappoo
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, United States of America
| | - Z Huczek
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - S Jedrzejczyk
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - S Cadet
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute and Artificial Intelligence in Medicine Program, Los Angeles, United States of America
| | - J Kwiecinski
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute and Artificial Intelligence in Medicine Program, Los Angeles, United States of America
| | - P Slomka
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute and Artificial Intelligence in Medicine Program, Los Angeles, United States of America
| | - B Rymuza
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - K.J Filipiak
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - D Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute and Artificial Intelligence in Medicine Program, Los Angeles, United States of America
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Grodecki K, Lin A, Cadet S, McElhinney PA, Razipour A, Chan C, Pressman B, Julien P, Maurovich-Horvat P, Gaibazzi N, Thakur U, Mancini E, Agalbato C, Menè R, Parati G, Cernigliaro F, Nerlekar N, Torlasco C, Pontone G, Slomka PJ, Dey D. Quantitative Burden of COVID-19 Pneumonia on Chest CT Predicts Adverse Outcomes: A Post-Hoc Analysis of a Prospective International Registry. Radiol Cardiothorac Imaging 2020; 2:e200389. [PMID: 33778629 PMCID: PMC7605078 DOI: 10.1148/ryct.2020200389] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
PURPOSE To examine the independent and incremental value of CT-derived quantitative burden and attenuation of COVID-19 pneumonia for the prediction of clinical deterioration or death. METHODS This was a retrospective analysis of a prospective international registry of consecutive patients with laboratory-confirmed COVID-19 and chest CT imaging, admitted to four centers between January 10 and May 6, 2020. Total burden (expressed as a percentage) and mean attenuation of ground glass opacities (GGO) and consolidation were quantified from CT using semi-automated research software. The primary outcome was clinical deterioration (intensive care unit admission, invasive mechanical ventilation, or vasopressor therapy) or in-hospital death. Logistic regression was performed to assess the predictive value of clinical and CT parameters for the primary outcome. RESULTS The final population comprised 120 patients (mean age 64 ± 16 years, 78 men), of whom 39 (32.5%) experienced clinical deterioration or death. In multivariable regression of clinical and CT parameters, consolidation burden (odds ratio [OR], 3.4; 95% confidence interval [CI]: 1.7, 6.9 per doubling; P = .001) and increasing GGO attenuation (OR, 3.2; 95% CI: 1.3, 8.3 per standard deviation, P = .02) were independent predictors of deterioration or death; as was C-reactive protein (OR, 2.1; 95% CI: 1.3, 3.4 per doubling; P = .004), history of heart failure (OR 1.3; 95% CI: 1.1, 1.6, P = .01), and chronic lung disease (OR, 1.3; 95% CI: 1.0, 1.6; P = .02). Quantitative CT measures added incremental predictive value beyond a model with only clinical parameters (area under the curve, 0.93 vs 0.82, P = .006). The optimal prognostic cutoffs for burden of COVID-19 pneumonia as determined by Youden's index were consolidation of greater than or equal to 1.8% and GGO of greater than or equal to 13.5%. CONCLUSIONS Quantitative burden of consolidation or GGO on chest CT independently predict clinical deterioration or death in patients with COVID-19 pneumonia. CT-derived measures have incremental prognostic value over and above clinical parameters, and may be useful for risk stratifying patients with COVID-19.
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Affiliation(s)
| | | | - Sebastien Cadet
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Priscilla A McElhinney
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Aryabod Razipour
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Cato Chan
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Barry Pressman
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Peter Julien
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Pal Maurovich-Horvat
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Nicola Gaibazzi
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Udit Thakur
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Elisabetta Mancini
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Cecilia Agalbato
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Roberto Menè
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Gianfranco Parati
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Franco Cernigliaro
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Nitesh Nerlekar
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Camilla Torlasco
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Gianluca Pontone
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Piotr J Slomka
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
| | - Damini Dey
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA (K.G., A.L., P.A.M., A.R., D.D.); Monash Health, Melbourne, Australia (A.L., U.T., N.N.); Department of Imaging, Cedars-Sinai Medical Center (S.C., C.C., B.P., P.J.); Department of Radiology, Semmelweis University, Budapest, Hungary (P.M.); Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma Italy (N.G.); Centro Cardiologico Monzino IRCCS, University of Milan, Italy (E.M., C.A., G.P.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy (R.M., G.P., F.C., C.T.); Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA (P.J.S.)
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Grodecki K, Opolski MP. Letter: Refining the prediction of side branch occlusion following percutaneous coronary intervention in bifurcation lesions. EUROINTERVENTION 2020; 16:e525-e526. [PMID: 32763866 DOI: 10.4244/eij-d-19-01107l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Grodecki K, Cadet S, Staruch A, Michałowska A, Kepka C, Wolny R, Slomka P, Witkowski A, Dey D, Opolski M. Computed Tomographic Quantitative Plaque Analysis Improves Prediction Of Side Branch Occlusion After Intervention In Coronary Bifurcation Lesions. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.160] [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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Grodecki K, Opolski MP, Staruch AD, Michalowska AM, Kepka C, Wolny R, Pregowski J, Kruk M, Debski M, Debski A, Michalowska I, Witkowski A. Comparison of Computed Tomography Angiography Versus Invasive Angiography to Assess Medina Classification in Coronary Bifurcations. Am J Cardiol 2020; 125:1479-1485. [PMID: 32276762 DOI: 10.1016/j.amjcard.2020.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022]
Abstract
The Medina classification is used to determine the presence of significant stenosis (≥50%) within each of the 3 arterial segments of coronary bifurcation in invasive coronary angiography (ICA). The utility of coronary computed tomography angiography (coronary CTA) for assessment of Medina classification is unknown. We aimed to compare the agreement and reproducibility of Medina classification between ICA and coronary CTA, and evaluate its ability to predict side branch (SB) occlusion following percutaneous coronary intervention (PCI). In total 363 patients with 400 bifurcations were included, and 28 (7%) SB occlusions among 26 patients were noted. Total agreement between CTA and ICA for assessment of Medina class was poor (kappa = 0.189), and discordance between both modalities was noted in 253 (63.3%) lesions. Larger diameter ratio between main vessel and SB in CTA, and larger bifurcation angle in ICA were independently associated with discordant Medina assessment. Whereas the interobserver agreement on Medina classification in CTA was moderate (kappa = 0.557), only fair agreement (kappa = 0.346) was observed for ICA. Finally, Medina class with any proximal involvement of main vessel and SB (1.X.1) on CTA or ICA was the most predictive of SB occlusion following PCI with no significant differences between both modalities (area under the curve 0.686 vs 0.663, p = 0.693, respectively). In conclusion, Medina classification was significantly affected by the imaging modality, and coronary CTA improved reproducibility of Medina classification compared with ICA. Both CTA and ICA-derived Medina class with any involvement of the proximal main vessel and SB was predictive of SB occlusion following PCI.
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Opolski MP, Grodecki K, Staruch AD, Michalowska AM, Kepka C, Wolny R, Knaapen P, Schumacher SP, Pregowski J, Kruk M, Debski M, Debski A, Michalowska I, Witkowski A. Accuracy of RESOLVE score derived from coronary computed tomography versus visual angiography to predict side branch occlusion in percutaneous bifurcation intervention. J Cardiovasc Comput Tomogr 2019; 14:258-265. [PMID: 31806391 DOI: 10.1016/j.jcct.2019.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/31/2019] [Revised: 09/29/2019] [Accepted: 11/20/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Visually estimated angiographic V-RESOLVE score was developed as a simple and accurate prediction tool for side branch (SB) occlusion in patients undergoing coronary bifurcation intervention. Data on the use of coronary computed tomography angiography (coronary CTA) for guiding percutaneous coronary intervention in bifurcation lesions is scarce. OBJECTIVES We aimed to validate the ability of quantitative CTA-derived RESOLVE score for predicting SB occlusion in coronary bifurcation intervention and to compare its predictive value with that of the angiography-based V-RESOLVE score. METHODS We included 363 patients with 400 bifurcation lesions. Angiographic V-RESOLVE score and CTA-derived RESOLVE score were calculated utilizing the weights from the QCA-based RESOLVE score. The scoring systems were divided into quartiles, and classified as the non-high-risk group and the high-risk group. Accuracy was assessed using areas under the receiver-operator characteristic curve (AUC). SB occlusion was defined as any decrease in Thrombolysis in Myocardial Infarction flow grade (including the absence of flow) in the SB after main vessel stenting. RESULTS In total, 28 SB occlusions (7%) occurred. CTA-derived RESOLVE and V-RESOLVE scores achieved comparable predictive accuracy (0.709 vs. 0.752, respectively, p = 0.531) for predicting SB occlusion, and the analysis of AUC for each constituent element of the scores did not show any significant difference between CTA and visual angiography. The total net reclassification index was -18.6% (p = 0.194), and there were no significant differences in the rates of SB occlusion in the non-high-risk group (4.9% vs. 3.8%, p = 0.510) and the high-risk group (13.8% vs. 18.6%, p = 0.384) between CTA-derived RESOLVE and V-RESOLVE scores. CONCLUSIONS The quantitative CTA-derived RESOLVE score is an accurate and reliable alternative to the visually estimated angiographic V-RESOLVE score for prediction of SB occlusion in coronary bifurcation intervention. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03709836.
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Affiliation(s)
- Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
| | - Kajetan Grodecki
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland; Medical University of Warsaw, Warsaw, Poland
| | - Adam D Staruch
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Anna M Michalowska
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland; Medical University of Warsaw, Warsaw, Poland
| | - Cezary Kepka
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Rafal Wolny
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jerzy Pregowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kruk
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Debski
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Artur Debski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | | | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
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Opolski MP, Wolny R, Grodecki K, Debski A, Witkowski A. Intravascular lithotripsy for heavily calcified subtotal occlusion of right coronary artery. Cardiol J 2019; 26:608. [PMID: 31701512 DOI: 10.5603/cj.2019.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/23/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland.
| | - Rafał Wolny
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Kajetan Grodecki
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland.,Medical University of Warsaw, Poland
| | - Artur Debski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
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Jędrzejczyk S, Scisło P, Grodecki K, Rymuza B, Kochman J, Huczek Z. TAVI-in-TAVI - Is this the future? Cardiol J 2019; 26:614-615. [PMID: 31701515 DOI: 10.5603/cj.2019.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Szymon Jędrzejczyk
- I Chair and Department of Cardiology Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland
| | - Piotr Scisło
- I Chair and Department of Cardiology Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland.
| | - Kajetan Grodecki
- I Chair and Department of Cardiology Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland
| | - Bartosz Rymuza
- I Chair and Department of Cardiology Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland
| | - Janusz Kochman
- I Chair and Department of Cardiology Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland
| | - Zenon Huczek
- I Chair and Department of Cardiology Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland
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Grodecki K, Huczek Z, Filipiak KJ. Commentary: Extended Reality in Percutaneous Interventions: Toward a Revolution, but in Baby Steps. J Endovasc Ther 2019; 26:548-549. [PMID: 31218928 DOI: 10.1177/1526602819855482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kajetan Grodecki
- 1 Ist Department of Cardiology, Medical University of Warsaw, Poland
| | - Zenon Huczek
- 1 Ist Department of Cardiology, Medical University of Warsaw, Poland
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Scisło P, Grodecki K, Wilimski R, Rymuza B, Kochman J, Opolski G, Huczek Z. Different types of endocarditis after transcatheter aortic valve implantation. Echocardiography 2019; 36:1132-1138. [PMID: 31012135 DOI: 10.1111/echo.14346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/30/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Infective endocarditis (IE) may take different faces in patients after transcatheter aortic valve implantation (TAVI). OBJECTIVES The primary aim of this study was to describe echocardiographic and clinical characteristics of TAVI's patients suffered from IE. METHODS In a single-center, retrospective study we analyzed 311 consecutive patients treated with TAVI for severe aortic stenosis between 2010 and 2018. RESULTS According to modified Duke criteria, we confirmed IE in 2.2% of the cohort, however PVE of TAVI's valve in 1.2% only; rest of the group suffered from CDRiE and IE of the mitral valve. In PVE's group vegetations were localized inside the frame with or without bioprosthesis moderate stenosis or regurgitation. Only 1 pts developed significant TAVI's bioprosthesis' paravalvular leak. We observed no native aortic anulus involvement. Mortality rate in the PVE-TAVI's group was 75% regardless of the type of treatment. CONCLUSIONS The above findings show that IE following TAVI is a serious complication and various scenarios (also CDRiE and native valve IE) should be considered.
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Affiliation(s)
- Piotr Scisło
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Kajetan Grodecki
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Rymuza
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Zenon Huczek
- Ist Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Scisło P, Grodecki K, Bińczak D, Kochman J, Wilimski R, Huczek Z. Valve-in-valve treatment of dysfunctional aortic bioprostheses - single-centre experience. Postepy Kardiol Interwencyjnej 2018; 14:425-428. [PMID: 30603033 PMCID: PMC6309840 DOI: 10.5114/aic.2018.79872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 09/03/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Piotr Scisło
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Kajetan Grodecki
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dana Bińczak
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Radosław Wilimski
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Zenon Huczek
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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