Right ventricular dysfunction by computed tomography associates with outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacementTOC summary: This study evaluated the presence of right ventricular dysfunction (RVD) by functional cardiac computed tomography angiography (CCTA) in 502 patients undergoing routine evaluation for transcatheter aortic valve replacement. CCTA-RVD was defined as right ventricular ejection fraction <50%, and was tested for its prognostic value beyond conventional risk factors and echocardiography. In our study, 25% of patients have RVD on CT that was not present on 2D echocardiography. CT-RVD provides independent prognostic value that is incremental to conventional clinical and echocardiographic characteristics, and therefore should be considered in routine risk stratification of patients with severe AS.
Prognostic impact of identifying etiology of prosthetic valve dysfunction with CTIn 132 patients with suspected PVD, an etiology was diagnosed on CT in 60.6% and on echocardiography in 34.1% patients. On adjusted multivariable analyses, CT diagnosis of structural valve degeneration was significantly associated with the composite outcome of reoperation or death whereas echocardiography diagnosis was not. CT assessment of PVD had prognostic significance for hard outcomes and should be considered in the diagnostic evaluation of patients with suspected PVD.
Clinical outcomes following transcatheter aortic valve implantation in patients with porcelain aortaCurrent guidelines favor transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement in patients with porcelain aorta (PAo). The clinical relevance of PAo in patients undergoing TAVI is however incompletely understood. The purpose of this study is to evaluate clinical outcome of patients with PAo undergoing TAVI.
Detection of small coronary calcifications in patients with Agatston coronary artery calcium score of zeroThe conventional Agatston coronary artery calcium score (CACS) method may fail to detect very small or less dense calcified plaques; smaller than 3 continuous pixels (1 mm2) or with a density lower than 130 Hounsfield Units (HU). A significant proportion of patients classified as CACS = 0, could potentially be reclassified as >0 by altering these thresholds. The increased sensitivity with lower HU threshold comes at a cost of reduced specificity by introducing false positive (noise) cases. Modifying the threshold to <1 mm 2 and HU > 120, allows 12.1% of patients with CACS = 0 to be reclassified as CACS> 0 while introducing only 0.9% of noise.
Budd-Chiari syndrome: A rare association of Scimitar syndromeA 3-year-old asymptomatic girl was noted to have a heart murmur. Chest X-ray showed a curvilinear shadow along the right heart border (Fig. 1A) characteristic of the Scimitar sign. Echocardiography revealed a Scimitar vein (SV) draining the entire right lung to the inferior vena cava (IVC) which was stenosed at the junction with SV (Fig. 1B; arrow). CT angiography and hepatic venography revealed a 1.5 cm-long segment of stenosis in the IVC proximal to the insertion of the SV, resulting in outflow obstruction of short hepatic veins (HVs) with resultant intrahepatic veno-venous collaterals which coursed to the IVC above the level of stenosis (Fig. 2).
Comparison of coronary atherosclerotic plaque progression in East Asians and Caucasians by serial coronary computed tomographic angiography: A PARADIGM substudyTo investigate potential differences in plaque progression (PP) between in East Asians and Caucasians as well as to determine clinical predictors of PP in East Asians.
Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registryThe role of change in fractional flow reserve derived from CT (FFRCT) across coronary stenoses (ΔFFRCT) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown.
Left ventricular assist device pseudo-thrombosis due to use of metal artifact reduction algorithm on cardiac CTProjection-based metal artifact reduction (p-MAR) is a CT technique in which projection data corrupted by metallic artifact is replaced by ‘estimated’ corrected values. This technique has shown promise with its ability to improve image quality in patients with metallic hardware or implants. p-MAR is becoming increasingly popular, as it can be used after image acquisition and does not lead to increase in the radiation dose to the patient.1 While the advantage of p-MAR for metal artifact reduction is well established, it may induce artifact in high-attenuation cardiovascular structures with attenuation characteristics similar to metal.
Prognostic value of myocardial perfusion imaging after first-line coronary computed tomography angiography: A multi-center cohort studyFurther diagnostic testing may be required after a coronary computed tomography angiography (CTA) showing suspected coronary stenosis. Whether myocardial perfusion imaging (MPI) provides further prognostic information post-CTA remains debated. We evaluated the prognosis for patients completing CTA stratified for post-CTA diagnostic work-up using real-world data.
Value of semiquantitative assessment of high-risk plaque features on coronary CT angiography over stenosis in selection of studies for FFRctThe degree of stenosis on coronary CT angiography (CCTA) guides referral for CT-derived flow reserve (FFRct). We sought to assess whether semiquantitative assessment of high-risk plaque (HRP) features on CCTA improves selection of studies for FFRct over stenosis assessment alone.
CT Evaluation by Artificial Intelligence for Atherosclerosis, Stenosis and Vascular Morphology (CLARIFY): A Multi-center, international studyAtherosclerosis evaluation by coronary computed tomography angiography (CCTA) is promising for coronary artery disease (CAD) risk stratification, but time consuming and requires high expertise. Artificial Intelligence (AI) applied to CCTA for comprehensive CAD assessment may overcome these limitations. We hypothesized AI aided analysis allows for rapid, accurate evaluation of vessel morphology and stenosis.
Smoking and obesity predict high-risk plaque by coronary CTA in low coronary artery calcium score (CACS)The AHA recommends statins in patients with CACS>100 AU. However in patients with low CACS (1–99 AU), no clear statement is provided, leaving the clinician in a grey-zone. High-risk plaque (HRP) criteria by coronary CTA are novel imaging biomarkers indicating a higher a-priori cardiovascular (CV) risk, which could help for decision-making. Therefore the objective of our study was to identify which CV-risk factors predict HRP in patients with low CACS 1–99.
Pericoronary adipose tissue CT attenuation and its association with serum levels of atherosclerosis-relevant inflammatory mediators, coronary calcification and major adverse cardiac eventsIncreased attenuation of pericoronary adipose tissue (PCAT) around the right coronary artery (RCA) derived from coronary CTA might detect coronary inflammation. We investigated a potential association between RCA PCAT attenuation and serum levels of atherosclerosis-relevant cytokines and MACE (coronary revascularization, myocardial infarction and/or cardiac death).
CTA pulmonary artery enlargement in patients with severe aortic stenosis: Prognostic impact after TAVRTAVR is highly effective at reducing mortality of patients with severe aortic stenosis. However, despite the high rates of procedural success, some patients do not achieve a functional benefit or die within a short time period after the procedure. Pulmonary hypertension is a known predictor of poor outcome in patients undergoing TAVR and correlates strongly with PA enlargement measured on CT. Our study shows that MPA enlargement, defined as area-MPA ≥7.40 cm2 on pre-procedural CTA, is an independent predictor of 1-year mortality after TAVR. This imaging marker could be relevant in improving individual risk classification in TAVR candidates.
The accuracy of coronary CT angiography in patients with coronary calcium score above 1000 Agatston Units: Comparison with quantitative coronary angiographyHigh amounts of coronary artery calcium (CAC) pose challenges in interpretation of coronary CT angiography (CCTA). The accuracy of stenosis assessment by CCTA in patients with very extensive CAC is uncertain.
Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patientsCoronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated.
Cardiac computed tomography in the contemporary evaluation of infective endocarditisIncreasing data have accumulated on the role of Cardiac Computed Tomography (CCT) in infective endocarditis (IE) with high accuracy for large vegetations, perivalvular complications and for exclusion of coronary artery disease to avoid invasive angiography. CCT can further help to clarify the etiology of infective prosthetic valve dysfunction (e.g. malposition, abscess, leak, vegetation or mass). Structural interventions have increased the relevance of CCT in valvular heart disease and have amplified its use.
Multi-modality imaging and operative findings of a post-TAVR ventricular septal defectMichael Morris: Consultant for Edwards Lifesciences. Educational training for Medtronic.
Prosthesis-patient mismatch defined by cardiac computed tomography versus echocardiography after transcatheter aortic valve replacementEvaluation of prosthesis-patient mismatch (P-PM) after transcatheter aortic valve replacement (TAVR) by transthoracic echocardiography (TTE) has provided conflicting results regarding its impact on outcomes. Whether post-TAVR computed tomography angiography (CTA) evaluation of P-PM can improve our understanding is unknown. We aimed to evaluate the inter-modality (TTE vs. CTA) agreement, inter-valve platform (balloon-expanding valve [BEV] vs. self-expandable valve [SEV]) differences in P-PM severity, and outcomes related to P-PM after TAVR.
CT assessment of the left atrial appendage post-transcatheter occlusion – A systematic review and meta analysisTransesophageal echocardiography (TEE) is the standard imaging modality used to assess the left atrial appendage (LAA) after transcatheter device occlusion. Cardiac computed tomography angiography (CCTA) offers an alternative non-invasive modality in these patients. We aimed to conduct a comparison of the two modalities.
Multiphase TAVR CT identifies unexpected sticky situation (Mechanical mitral valve leaflet dysfunction and bicuspid aortic valve)60-year-old female with history of 33mm ATS mechanical mitral valve replacement 16 years ago for rheumatic mitral valve disease and permanent Atrial Fibrillation (AF) presented with one-year history of worsening exertional dyspnoea as well as symptom of pre-syncope. She was on warfarin for AF as well as mechanical mitral valve replacement (MVR) with therapeutic anticoagulation in the recent time. Her transthoracic echocardiogram was technically difficult as MVR leaflet motion and aortic valve morphology was not well visualised because of artefact from mechanical mitral valve (Panel 1 A: 4chamber still echo image showing reverberation artefact from mechanical mitral valve leaflets)) and aortic valve calcification.
Diagnostic performance of cardiac computed tomography versus transesophageal echocardiography in infective endocarditis: A contemporary comparative meta-analysisCondensed abstract Data regarding the comparison of diagnostic accuracy of TEE and CCT for diagnosing IE are limited. The present meta-analysis compares the diagnostic performance of the two imaging modalities for a variety of complications of IE in the same patient populations. Our results show that both TEE and CCT have good diagnostic accuracy, with TEE showing superiority in detecting leaflet defects and CCT performing better in prosthetic valve endocarditis. CCT also showed a trend towards higher sensitivity than TEE for detection of periannular complications. These findings suggest that CCT is a useful adjunct to TEE for IE, whenever appropriate use of complementary imaging modalities is warranted.
Coronary sinus to left atrium fistula on computed tomography angiography: Differentiation from unroofed coronary sinus with literature reviewAtrial septal defect
Clinical impact of mitral calcium volume in patients undergoing transcatheter aortic valve implantationMitral annular calcification (MAC) has been associated with mitral valve (MV) disease and cardiovascular events in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the incidence and impact of mitral calcium volume (MCV) quantified by multidetector computed tomography (MDCT) on MV function and clinical outcomes after TAVI.
The clinical utility of FFRCT stratified by ageCT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFRCT) is a safe alternative to invasive coronary angiography. A negative FFRCT has been shown to have low cardiac event rates compared to those with a positive FFRCT. However, the clinical utility of FFRCT according to age is not known.