Mulitmedia Library
Systolic or diastolic CT image acquisition for transcatheter aortic valve replacement – An outcome analysis
Computed tomography (CT) imaging is the standard of care before transcatheter aortic valve replacement (TAVR). The aortic annulus undergoes conformational changes during the heart cycle. Therefore, the image acquisition time point can impact prosthesis sizing and fit. Clinical outcome data are lacking. The aim of this study was to compare systolic and diastolic cardiac CT data acquisition with regard to procedural and clinical outcomes in patients undergoing TAVR for severe aortic stenosis (AS).Coronary CTA plaque volume severity stages according to invasive coronary angiography and FFR
Atherosclerotic plaque characterization by coronary computed tomography angiography (CCTA) enables quantification of coronary artery disease (CAD) burden and type, which has been demonstrated as the strongest discriminant of future risk of major adverse cardiac events (MACE). To date, there are no clinically useful thresholds to assist with understanding a patient's disease burden and guide diagnosis and management, as there exists with coronary artery calcium (CAC) scoring. The purpose of this manuscript is to establish clinically relevant plaque stages and thresholds based on evidence from invasive angiographic stenosis (ICA) and fractional flow reserve (FFR) data.Are risk factors necessary for pretest probability assessment of coronary artery disease? A patient similarity network analysis of the PROMISE trial
Pretest probability (PTP) calculators utilize epidemiological-level findings to provide patient-level risk assessment of obstructive coronary artery disease (CAD). However, their limited accuracies question whether dissimilarities in risk factors necessarily result in differences in CAD. Using patient similarity network (PSN) analyses, we wished to assess the accuracy of risk factors and imaging markers to identify ≥50% luminal narrowing on coronary CT angiography (CCTA) in stable chest-pain patients.Prognostic value of computed tomography derived fractional flow reserve for predicting cardiac events and mortality in kidney transplant candidates
Cardiac screening using coronary computed tomography angiography (CCTA) in kidney transplant candidates before transplantation yields both diagnostic and prognostic information. Whether CT-derived fractional flow reserve (FFRCT) analysis provides prognostic information is unknown. This study aimed to assess the prognostic value of FFRCT for predicting major adverse cardiac events (MACE) and all-cause mortality in kidney transplant candidates.Prospective evaluation of the learning curve and diagnostic accuracy for Pre-TAVI cardiac computed tomography analysis by cardiologists in training: The LEARN-CT study
To investigate the learning curve and the minimum number of cases required for a cardiologist in training to acquire the skills to an accurate pre-TAVI cardiac CT (CCT) analysis using a semi-automatic software.Diagnostic concordance and discordance between angiography-based quantitative flow ratio and fractional flow reserve derived from computed tomography in complex coronary artery disease
Both quantitative flow ratio (QFR) and fractional flow reserve derived from computed tomography (FFRCT) have shown significant correlations with invasive wire-based fractional flow reserve. However, the correlation between QFR and FFRCT is not fully investigated in patients with complex coronary artery disease (CAD). The aim of this study is to investigate the correlation and agreement between QFR and FFRCT in patients with de novo three-vessel disease and/or left main CAD.Coronary volume to left ventricular mass ratio in patients with diabetes mellitus
Diabetes mellitus is a major risk factor for coronary artery disease (CAD) and may provoke structural and functional changes in coronary vasculature. The coronary volume to left ventricular mass (V/M) ratio is a new anatomical parameter capable of revealing a potential physiological imbalance between coronary vasculature and myocardial mass. The aim of this study was to examine the V/M derived from coronary computed tomography angiography (CCTA) in patients with diabetes.Reproducibility of 4D cardiac computed tomography feature tracking myocardial strain and comparison against speckle-tracking echocardiography in patients with severe aortic stenosis
Myocardial strain is an established parameter for the assessment of cardiac function and routinely derived from speckle tracking echocardiography (STE). Novel post-processing tools allow deformation imaging also by 4D cardiac computed tomography angiography (CCT). This retrospective study aims to analyze the reproducibility of CCT strain and compare it to that of STE.Increased coronary pericoronary adipose tissue attenuation in diabetic patients compared to non-diabetic controls: A propensity score matching analysis
Pericoronary adipose tissue (PCAT) attenuation is an indicator of active inflammation of perivascular adipose tissue, which is supposed to increase in diabetic patients. We aimed to investigate the PCAT attenuation values and high-risk plaque (HRP) features in diabetic and non-diabetic subjects with different stenotic extents.IgG4-related disease: Coronary arteritis masquerading as coronary “masses”
A 64-year-old man with a history of psoriasis and latent tuberculosis presented to the emergency department with cough and dyspnea. Transthoracic echocardiogram (TTE) showed a large pericardial effusion with early echocardiographic signs of tamponade and a well circumscribed right atrioventricular groove mass extending into the pericardial space, moving with the cardiac cycle without independent mobility (Fig. 1). Pericardiocentesis drained 1 L of sanguinous fluid with a lymphocytic predominance and negative infectious and cytologic work-up.Live integration of comprehensive cardiac CT with electroanatomical mapping in patients with refractory ventricular tachycardia
Aim of the present study was to verify the feasibility and accuracy of live integration of myocardial fibrosis evaluated at CCT with EAM (electro-anatomical mapping).Deep learning model to quantify left atrium volume on routine non-contrast chest CT and predict adverse outcomes
Table of Contents Summary: We aimed to validate a deep learning model to automatically quantify left atrial (LA) volumes from routine non-contrast chest CT and evaluate prediction for cardiovascular outcomes. We evaluated 273 patients (median age 69 years, 55.5% male) who underwent a routine non-ECG gated NCCT for lung cancer screening. LA volumes were quantified by three expert cardiothoracic radiologists and a prototype AI algorithm. There was excellent correlation between AI and expert results. AI-derived LA volumes were associated with increased risk of major adverse cardiac events, heart failure hospitalization, and new-onset atrial fibrillation within five years.Impact of computed-tomography defined sarcopenia on outcomes of older adults undergoing transcatheter aortic valve implantation
The adoption of Computed tomography (CT)-defined sarcopenia to risk stratify transcatheter aortic valve implantation (TAVI) candidates remains limited by a lack of both standardized definition and evidence of independent value over currently adopted mortality prediction tools.The impact of hypo-attenuated leaflet thickening on haemodynamic valve deterioration following transcatheter aortic valve replacement
186 patients were prospectively recruited following transcatheter aortic valve replacement (TAVR) for hypo-attenuated leaflet thickening (HALT) on computed-tomography (CT) imaging and to determine its impact on haemodynamic valve deterioration (HVD). Routine echocardiograms at discharge, one month and annually were performed. LT prevalence was 17.7% and HVD was present in 8.6% of the total cohort. HALT was the only independent predictor of HVD. Thresholds for HALT predicting HVD were a cumulative depth of 2.4 mm and cumulative area of 28 mm2. HALT is an independent predictor of HVD, which exhibits specific depth and area thresholds for HVD prediction.Cumulative exposure amount of PM2.5 in the ambient air is associated with coronary atherosclerosis - Serial coronary CT angiography study
TOC SUMMARY: It is unclear how air pollution contributes to the development of cardiovascular disease. We investigated the change of coronary atherosclerosis using serial CCTAs in relation to the cumulative amount of PM2.5 exposure between the two CCTAs in 3,127 healthy adults. Coronary calcification progressed in 1,361 (43.5%) subjects with a positive relationship between the cumulative amount of PM2.5 exposure and CACS. The cumulative amount of PM2.5 exposure, rather than the average concentration of PM2.5, was independently associated with progression of coronary calcification and diffuse development of de novo calcified plaques, with its impact higher than any other traditional cardiovascular risk factors.Right ventricular dysfunction by computed tomography associates with outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacement
TOC 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 CT
In 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 aorta
Current 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 zero
The 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 syndrome
A 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 substudy
To 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 registry
The 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 CT
Projection-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 study
Further 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 FFRct
The 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.
