Mulitmedia Library
Mortality impact of low CAC density predominantly occurs in early atherosclerosis: explainable ML in the CAC consortium
Original TOC summary: We used SHAP, an explainable machine learning (ML) technique, to determine the risk predictive value and age interaction of coronary artery calcium (CAC) characteristics among 63,215 asymptomatic patients in the CAC consortium. The addition of CAC density and number of calcified vessels to an ML model with clinical characteristics + CAC did not improve prediction for all-cause mortality (p = 0.23), but did improve for cardiovascular mortality (p = 0.03). Lower CAC density increased mortality, particularly very low CAC density ≤0.75, which occurred predominantly in CAC1-100. Explainable ML should be applied in clinical research for transparent predictive modeling.Higher coronary artery calcium score is associated with increased risk of atrial fibrillation recurrence after catheter ablation
Coronary artery calcium score (CACS) is associated with an increased risk of atrial fibrillation (AF) development, but scarce data are available regarding the impact on AF recurrence. This study aims to assess the impact of CACS on AF recurrence following catheter ablation.Computed tomography imaging for subclinical leaflet thrombosis following surgical and transcatheter aortic valve replacement
Subclinical leaflet thrombosis (LT) may occur following surgical and transcatheter aortic valve replacement. Computed tomography (CT) has become an established imaging modality to diagnose subclinical LT following bioprosthetic aortic valve replacement. Even so, there is a limited (but growing) experience in utilizing CT imaging for this indication. This review emphasizes a systematic approach to acquiring and analysing CT imaging for subclinical LT, highlighting evidence surrounding clinical sequelae of subclinical LT and anti-thrombotic implications following diagnosis.The effect of patient and imaging characteristics on coronary CT angiography assessed pericoronary adipose tissue attenuation and gradient
Coronary CT angiography (CCTA) pericoronary adipose tissue (PCAT) markers are promising indicators of inflammation.Implications of computed tomography reconstruction algorithms on coronary atheroma quantification: Comparison with intravascular ultrasound
Advances in coronary computed tomography angiography (CCTA) reconstruction algorithms are expected to enhance the accuracy of CCTA plaque quantification. We aim to evaluate different CCTA reconstruction approaches in assessing vessel characteristics in coronary atheroma using intravascular ultrasound (IVUS) as the reference standard.Association of left ventricular diastolic function with coronary artery calcium score: A Project Baseline Health Study
Coronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are strong predictors of cardiovascular events and share common risk factors. However, their independent association remains unclear.Follow-up assessment of myocardial calcification secondary to fulminant myocarditis with computed tomography
A 16-year-old man underwent venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy due to hemodynamic collapse caused by viral fulminant myocarditis. Supplementary Figure 1 presents the time course of treatment. High-density areas wtihin the myocardium were initially detected by computed tomography (CT) 10 days after admission which was not observed on admission (Fig. 1A). The CT tissue attenuation value reached 106 Hounsfield Unit (HU) in these areas 40 days after admission (Fig. 1B), with changes in the left lateral wall being more evident than other areas.Comparison of coronary CT angiography-based and invasive coronary angiography-based quantitative flow ratio for functional assessment of coronary stenosis: A multicenter retrospective analysis
The aim of this study was to evaluate the diagnostic performance of coronary CT angiography (CTA)-based quantitative flow ratio (QFR), namely CT-QFR, and compare it with invasive coronary angiography (ICA)-based Murray law QFR (μQFR), using fractional flow reserve (FFR) as the reference standard.Multivessel coronary artery aneurysms as a complication of chronic active Epstein-Barr virus infection: An atypical and occasional complication
Coronary artery aneurysm (CAA) is defined as a coronary artery dilatation >1.5 times the diameter of the normal adjacent segments or the diameter of the patient's largest coronary vessel. It is an uncommon disease, present in 1–4% of coronary angiography findings.1Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiography
Inflammation surrounding the coronary arteries can be non-invasively assessed using pericoronary adipose tissue attenuation (PCAT). While PCAT holds promise for further risk stratification of patients with low coronary artery disease (CAD) prevalence, its value in higher risk populations remains unknown.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.CT Evaluation by Artificial Intelligence for Atherosclerosis, Stenosis and Vascular Morphology (CLARIFY): A Multi-center, international study
Atherosclerosis 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 events
Increased 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 TAVR
TAVR 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 angiography
High 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 patients
Coronavirus 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 endocarditis
Increasing 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 defect
Michael Morris: Consultant for Edwards Lifesciences. Educational training for Medtronic.Prosthesis-patient mismatch defined by cardiac computed tomography versus echocardiography after transcatheter aortic valve replacement
Evaluation 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 analysis
Transesophageal 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-analysis
Condensed 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 review
Atrial septal defectClinical impact of mitral calcium volume in patients undergoing transcatheter aortic valve implantation
Mitral 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 age
CT 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.Predictive value of the coronary artery calcium score and advanced plaque characteristics: Post hoc analysis of the PREDICT registry
Whether coronary plaque characteristics assessed in coronary computed tomography angiography (CCTA) in association with the coronary artery calcium score (CACS) have predictive value for coronary events is unclear. We aimed to examine the predictive value of the CACS and plaque characteristics for the occurrence of coronary events.Cardiovascular CT in a world adrift
The pandemic has changed many things, how we work, how we live and how we learn. At the time of writing, SCCT had just completed our 15th Annual Scientific Meeting, still in the middle of a global COVID-19 pandemic.Annular versus supra-annular sizing for transcatheter aortic valve replacement in bicuspid aortic valve disease
CT measurement of supra-annular area (SA) has been proposed as an alternative to annular area (AA) for sizing of trancatheter valves in biscuspid aortic valves (BAV). This study examines the reproducibility of SA and AA measurements and their potential impact on downstream transcatheter heart valve sizing and clinical outcomes.Accelerating the future of cardiac CT: Social media as sine qua non?
The vision for the Journal of Cardiovascular Computed Tomography's social media efforts is to amplify the impact of the Journal while driving engagement, increasing journal visibility and disseminating content to new audiences globally. Serving as “the front door” to the Journal, this digital evolution represents an important step forward for a field in which advancements in hardware, image processing and clinical evidence have evolved rapidly. However, is social media the panem et circenses of cardiovascular computed tomography (CT), that of superficial appeasement, or of sine qua non; an essential ingredient to the acceleration of the Journal and of the field of cardiovascular CT? This paper aims to present the initial impact of social media within a dedicated cardiovascular CT journal.Percent atheroma volume: Optimal variable to report whole-heart atherosclerotic plaque burden with coronary CTA, the PARADIGM study
Different methodologies to report whole-heart atherosclerotic plaque on coronary computed tomography angiography (CCTA) have been utilized. We examined which of the three commonly used plaque burden definitions was least affected by differences in body surface area (BSA) and sex.A pooled-analysis of age and sex based coronary artery calcium scores percentiles
Age and sex based coronary artery calcium score (CAC) percentiles have been used to improve coronary artery disease (CAD) risk prediction. However, the main limitation of the CACs percentiles currently in use is that they are often based on single studies. We performed a pooled analysis of all available studies that reported on CAC percentiles, in order to develop more generalizable age and sex nomograms.Bicuspid aortic valve sizing for transcatheter aortic valve implantation: Development and validation of an algorithm based on multi-slice computed tomography
No indication are available for transcatheter aortic valve implantation (TAVI) sizing in bicuspid aortic valve (BAV). Aim of the study is to develop and validate a Multi-Slice Computed Tomography (MSCT)-based algorithm for transcatheter heart valve (THV) sizing in patients with stenotic BAV under evaluation for TAVI.Adoption of coronary artery disease - Reporting and Data System (CAD-RADS™) and observed impact on medical therapy and systolic blood pressure control
CAD-RADS was developed to standardize communication of per-patient maximal stenosis on coronary CT angiography (CCTA) and provide treatment recommendations and may impact primary prevention care and resource utilization. The authors sought to evaluate CAD-RADS adoption on preventive medical therapy and risk factor control amongst a mixed provider population.Validation of deep-learning image reconstruction for coronary computed tomography angiography: Impact on noise, image quality and diagnostic accuracy
The present study evaluated the impact of deep-learning image reconstruction (DLIR) on noise, image quality, and diagnostic accuracy. In 43 patients who underwent clinically indicated coronary CT angiography and invasive coronary angiography, image quality was improved by up to 62% at similar noise levels. In addition, DLIR-H yielded the highest noise reduction (up to 43%) and best image quality (improvement of up to 138%). More importantly, sensitivity (92% vs. 88%), specificity (73% vs. 73%) and diagnostic accuracy (82% vs. 80%) of DLIR were at least non-inferior to ASiR-V.Right-sizing cardiac CT reimbursement through local and national efforts: A call to action for the imaging community
The proposed 2020 CMS Physician Fee Schedule (MFPS) and Hospital Outpatient Prospective Payment System (OPPS) rules issued a reduction in the technical component (TC) payment that would decrease reimbursement for cardiac CT codes by nearly 29% compared to the 2018 final rule. Cardiac CT codes are currently allocated to ambulatory payment classification (APC) 5571, which is used for level I imaging tests with contrast. However, cardiac CT exams utilize more resources and are very different in clinical scope.Aortic valve calcification as a risk factor for major complications and reduced survival after transcatheter replacement
Aortic valve calcification is supposed to be a possible cause of embolic stroke or subclinical valve thrombosis after transcatheter aortic valve replacement (TAVR). We aimed to assess the role of aortic valve calcification in the occurrence of in-hospital clinical complications and survival after TAVR.Coronary atherosclerosis scoring with semiquantitative CCTA risk scores for prediction of major adverse cardiac events: Propensity score-based analysis of diabetic and non-diabetic patients
We aimed to compare semiquantitative coronary computed tomography angiography (CCTA) risk scores – which score presence, extent, composition, stenosis and/or location of coronary artery disease (CAD) – and their prognostic value between patients with and without diabetes mellitus (DM). Risk scores derived from general chest-pain populations are often challenging to apply in DM patients, because of numerous confounders.Baseline global longitudinal strain by computed tomography is associated with post transcatheter aortic valve replacement outcomes
Computed tomography angiography derived global longitudinal strain (CTA-GLS) has been shown to be feasible, however its prognostic value remains unclear in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). We evaluated the association of baseline CTA-GLS with outcomes including all-cause mortality and composite endpoint of death and heart failure hospitalization in 223 patients treated with TAVR. Patients with normal LVEF but reduced CTA-GLS had similar event rate to those with impaired LVEF, and higher than those with normal LVEF and preserved CTA-GLS. Baseline CTA-GLS assessment might be helpful in patients with difficult echocardiographic images undergoing TAVR evaluation.Risk stratification of coronary plaques using physiologic characteristics by CCTA: Focus on shear stress
The identification of factors determining whether a lesion progresses, destabilizes or becomes quiescent remains a challenge. Wall or endothelial shear stress (WSS or ESS, respectively), the frictional force acting on the lumen wall, is strongly associated with changes in the natural history of lesions. Several clinical intravascular imaging studies have shown a clear link between disturbed flow, typically characterized by low WSS, and plaque growth. In support of these studies, in-vitro experiments of shear stress have identified several mechanisms promoting atherosclerosis.Power of zero stronger than “soft” plaque
The authors nicely demonstrate,1 in a mixed cohort of asymptomatic and symptomatic patients, that the prevalence of non-calcified plaque is not insignificant among those persons with calcium score of zero. Understanding the differences between the symptomatic and asymptomatic cohorts are most important and that wasn't well delineated in the manuscript. Prevalence of disease, significance of non-calcified plaque and pre-test probability are all important factors that vary based on symptomatology.Low-kV coronary artery calcium scoring with tin filtration using a kV-independent reconstruction algorithm
To investigate the accuracy of Agatston scoring and potential for radiation dose reduction of a coronary artery calcium scoring (CACS) CT protocol at 100 kV with tin filtration (Sn100kV) and kV-independent iterative reconstruction, compared to standard 120 kV acquisitions.Predicting the outcome of transcatheter mitral valve implantation using image-based computational models
The appropriate placement and size selection of mitral prostheses in transcatheter mitral valve implantation (TMVI) is critical, as encroachment on the left ventricular outflow tract (LVOT) may lead to flow obstruction. Recent advances in computed tomography (CT) can be employed for pre-procedural planning of mitral prosthetic valve placement. This study aims to develop patient-specific computational fluid dynamics models of the left ventricle (LV) in the presence of a mitral valve prosthesis to investigate blood flow and LVOT pressure gradient during systole.Influence of operator expertise and coronary luminal segmentation technique on diagnostic performance, precision and reproducibility of reduced-order CT-derived fractional flow reserve technique
Onsite workstation-based CT-derived Fractional-Flow-Reserve (CT-FFR) is accurate in assessing hemodynamic-significance of coronary stenoses. We aim to describe the influence of operator expertise and luminal-segmentation technique on the diagnostic performance, precision and reproducibility of CT-FFR in identifying hemodynamically-significant stenosis (FFR≤0.8).Comparison of fractional myocardial mass, a vessel-specific myocardial mass-at-risk, with coronary angiographic scoring systems for predicting myocardial ischemia
The burden of coronary artery disease has been assessed by various semi-quantitative angiographic scores, which are frequently different each other. A non-invasive and quantitative modality may substitute angiographic sores for prognostic implication and decision of revascularization strategy. We compared fractional myocardial mass (FMM) with angiographic scores for predicting myocardial ischemia.Reference values for mid-diastolic right ventricular volume in population referred for cardiac computed tomography: An additional diagnostic value to cardiac computed tomography
While an assessment of the right ventricular (RV) size remains challenging, the entire RV is can be imaged on coronary computed tomography angiography (CCTA) studies. With prospective ECG-triggering, the RV end diastolic volume (RVEDV) cannot be measured; however, the RV mid-diastolic volume (RVMDV) can still be measured accurately from routine CCTA data sets. The objective of this study is to establish normal reference values for RVMDV.Accuracy of RESOLVE score derived from coronary computed tomography versus visual angiography to predict side branch occlusion in percutaneous bifurcation intervention
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.A novel density-volume calcium score by non-contrast CT predicts coronary plaque burden on coronary CT angiography: Results from the MACS (Multicenter AIDS cohort study)
The purpose of this study is to determine if a new score calculated with coronary artery calcium (CAC) density and volume is associated with total coronary artery plaque burden and composition on coronary CT angiography (CCTA) compared to the Agatston score (AS).State-of-the-art-myocardial perfusion stress testing: Static CT perfusion
Large multicenter studies and meta-analysis have documented the diagnostic accuracy and the prognostic implications of stress echocardiography, cardiac magnetic resonance and, mainly, nuclear stress tests. However, none of them provides a comprehensive anatomical and functional evaluation within the same study as stress CT perfusion. Myocardial CT perfusion is the only non-invasive modality that allows to quantifying coronary stenosis and determining its functional relevance, constituting a potential “one-stop-shop” method for the diagnosis and global management of patients with known or suspected coronary artery disease.Occlusion of the left main coronary artery ostium by aortic valve cusp fusion in an adult
A 46-year-old female was admitted to hospital because of dyspnea and chest pain for 2 months with no apparent symptoms in the past years. She had no family history of sudden death or cardiac disorder. ECG showed a paroxysmal atrial fibrillation. Coronary CT was performed, revealing normal right coronary artery and pouch-like filling in the small left coronary aortic sinus that seemed to be covered by the thickened rudimentary left coronary cusp (Fig. A,B,C). Transcatheter coronary angiography showed occlusion of the left main coronary artery ostium and was supplied by a major collateral artery from right coronary artery (Fig.Differences in left ventricular measurements: Attenuation versus contour based methods
Coronary computed tomography angiography (CCTA) left ventricle (LV) volumes have prognostic value. LV measurements however can differ depending on post-processing software. Two common methods are the contour (CON) or attenuation (ATT) based methods. This study aims to determine differences in LV volume measurements using the 2 methods.Cardiovascular morbidity and mortality in patients with aortic valve calcification: A systematic review and meta-analysis
Aortic valve calcification (AVC) is an active process that involves inflammation, disorganization of matrix disposition, lipid accumulation and lamellar bone formation. AVC without hemodynamic changes has been associated with cardiovascular (CV) risk factors and increased risk of coronary and CV events. Nowadays, echocardiography is the standard imaging technique to evaluate aortic valve pathologies. However, cardiac computed tomography (CT) allows high accuracy and reproducible measurement of AVC, without exposing the patients to excessive radiation or contrast administration.Dynamic CT perfusion imaging: Few small steps toward the implementation into the real clinical world
Coronary CT angiography (CCTA) is a well-established, non-invasive imaging modality with excellent diagnostic accuracy in the identification of coronary atherosclerosis and detection of obstructive coronary artery disease (CAD) when compared to invasive coronary angiography (ICA) as reference standard.1 Moreover, several randomized controlled trials have shown how the use of CCTA in the management of symptomatic patients with stable CAD improves patients’ outcomes, reducing the risk of long-term fatal and non-fatal myocardial infarction.Utilization of coronary computed tomography angiogram in evaluation of left ventricular thrombus
Left Ventricular (LV) thrombus may occur due to global or regional LV dysfunction, especially after acute anterior myocardial infarction (MI). LV thrombus has a critical clinical significance as it may lead to thromboembolic complications. Imaging strategies utilized in detecting LV thrombus include Echocardiogram (Echo) and Cardiac Magnetic Resonance Imaging (CMR). We present the following case to illustrate the role of Coronary Computed Tomography Angiogram (CCTA) in the evaluation of LV thrombus and its clinical significance in demonstrating fine surface details of the thrombus compared to Echo and CMR.Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain: Subgroup analysis of the ROMICAT II trial
Non-invasive fractional flow reserve (FFRCT) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFRCT in the population of acute chest pain patients and assessed the relationship of FFRCT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics.An unusual left anterior descending artery myocardial bridging
A 43 year-old man was admitted for transient (10 min) acute chest pain that was highly suggestive of angina and appeared after an unusual intense effort. He has no personal history and none of the traditional cardiovascular risk factors. Baseline electrocardiogram showed no repolarization abnormality. High-sensitivity cardiac troponin was undetectable (<4 ng/mL). Transthoracic echocardiography showed mild wall motion abnormalities (apical and septo-apical hypokinesia) and left ventricle ejection fraction was subnormal.Using a genetic risk score to calculate the optimal age for an individual to undergo coronary artery calcium screening
Genetic risk scores (GRSs) have been associated with CHD events and coronary artery calcium (CAC). We sought to evaluate the ability of a GRS to improve CAC as a screening test.Intracavitary right coronary artery - Or just a wrap? A cardiac CT imaging series
Intracavitary right coronary artery (RCA) is a very rare anomaly occurring in less than 0.1%1 and up to 0.4% reported by coronary computed tomography angiography (CTA).2 Literature is scarce, however its recognition is crucial, especially prior to surgical or interventional procedures such as coronary artery bypass graft (CABG) surgery, right heart catheterization or device implantation: Hereby the RCA is at risk of injury with fatal bleeding, or suturing a CABG anastomosis may be difficult or impossible.Anomalous left coronary artery from right pulmonary artery (ALCARPA) with dual left anterior descending arteries- a hitherto unreported combination of coronary anomalies diagnosed on dual source CT
An 8 month old infant was admitted to the hospital with worsening food intolerance and tachypnea. ECG showed deep Q waves in V4-V6. Echocardiography revealed an abnormally dilated left ventricle (5.5cm) with ejection fraction of 20%. In addition, the left coronary sinus was not seen to give arise to any coronary artery and the origin of left main coronary artery (LCA) could not be delineated. CT Angiography (CTA), being a non invasive method of choice to diagnose anomalous coronary anatomy, was done on a 384-slice dual source scanner (Siemens SOMATOM Force).Truncus arteriosus communis associated with interrupted aortic arch – Type B and right aberrant subclavian artery: A rare entity
An eutrophic one-day-old-girl was examined by regional pediatric cardiologist due to mild hypoxemia and systolic murmur. As transthoracic echocardiography (TTE) detected a nonspecific form of truncus arteriosus communis (TAC), the admission to cardiac intensive care unit without Prostaglandin E1 infusion was recommended. Except for elevated renal function parameters, the patient presented with diminished pulses and prolonged capillary refill time in all four extremities on admission. On one hand, TTE confirmed TAC with a nonstenotic truncal valve, isolated origins of pulmonary artery branches and turbulent flow at its distal part streaming to descending aorta, but could not clearly depict the aortic arch and its branches on the other hand.Highly atypical double barrel outlet to aorta in double inlet left ventricle, double outlet right ventricle
A full-term female was born to a mother whose pregnancy was complicated by prenatal diagnosis of complex congenital heart disease. A postnatal echocardiogram showed double inlet left ventricle, hypoplastic anteriorly placed outflow chamber {right ventricle (RV)} and possible double outlet right ventricle. Retrospective ECG-gated computed tomography angiography (CTA) with dose modulation was obtained to delineate complex intracardiac anatomy (Siemens dual source “Drive” scanner; temporal resolution 75 ms, 80 Kv, 48 mAs, Dose length product 19 mGycm).Anomalous origin of the left circumflex artery from the right coronary sinus with retro-aortic course: A potential malign variant
A 46-year-old man with an unremarkable past medical history and no cardiovascular risk factors was referred to perform cardiac magnetic resonance (CMR) for recent suspected myocarditis. CMR showed normal left ventricular volumes and systolic function, hypokinesis at the level of basal to mid inferolateral wall, and transmural late gadolinium enhancement with ischemic pattern was evident in the left circumflex artery territory at the basal and mid inferolateral wall (Fig. 1). To rule out the presence of obstructive coronary artery disease (CAD), an ECG-gated coronary computed tomography angiogram (CCTA) was performed, showing an anomalous origin of the circumflex coronary artery from the right coronary sinus with a retro-aortic course (Fig.Subtle sings of contained cardiac rupture following myocardial infarction
A 59-year-old man was admitted with a 2-h history of stabbing chest pain and dizziness. On arrival he was in shock with an arterial blood pressure of 70/30 mmHg and he had electrocardiographic changes suggestive of lateral ST elevation myocardial infarction (STEMI). Emergency invasive coronary angiography showed stenoses of left anterior descending (75–94%), circumflex (50–74%) and right (50–74%) coronary arteries along with a complete occlusion of a small obtuse marginal branch. None of these were treated with primary intervention.Evaluation of ventricular septal defects using high pitch computed tomography angiography of the chest in children with complex congenital heart defects below one year of age
Aim of this study was to assess the accuracy of ventricular septal defects (VSD) using high pitch computed tomography angiography (CTA) of the chest in children below 1 year of age, compared to the intraoperative findings and echocardiography.Quantified dual energy computed tomography perfusion imaging using myocardial iodine concentration: Validation using CT derived myocardial blood flow and invasive fractional flow reserve in a porcine model
In this study a porcine model of coronary artery disease with invasive fractional flow reserve was used to validate myocardial iodine content derived from dual energy imaging to other measures of myocardial perfusion including dynamic myocardial CT perfusion. FFR correlated strongly to MBF and modestly to myocardial iodine concentration and myocardial CT number. Myocardial iodine content was significantly different in normal and ischemic territories.A cross-sectional survey of coronary plaque composition in individuals on non-statin lipid lowering drug therapies and undergoing coronary computed tomography angiography
Non-statin therapy (NST) is used as second-line treatment when statin monotherapy is inadequate or poorly tolerated.A rare coronary anomaly -- type 4 dual left anterior descending artery accompanying anomalous origin of the left coronary artery from the right coronary sinus
Invasive coronary angiographyReproducibility of aortic valve calcification scoring with computed tomography – An interplatform analysis
To investigate whether aortic valve calcification (AVC) scoring performed with different workstation platforms generates comparable and thus software-independent results.Non-ECG gated CT in a case of takotsubo cardiomyopathy
We report a 60-year-old woman with a past history of thoracic aortic aneurysm (TAA) surgery and abdominal aortic aneurysm (AAA) who was admitted to our hospital complaining of chest pain. On admission, emergency non-electrocardiogram (ECG) gated contrast enhanced computed tomography (CT) was performed to rule out aortic dissection. CT revealed no remarkable changes in TAA or AAA (not shown here). However, apical ballooning, thinning of the apical wall and thickening of the basal wall were observed, together with normal apical wall enhancement (Fig.Reply: Impact of diabetes on coronary artery plaque volume by coronary CT angiography and subsequent adverse cardiac events
We would like to thank Dr. Kawada for his interest and effort spent to comment on our manuscript. He raises two interesting queries which we would like to respond to. His first query relates to the analysis of adverse outcome based upon quantified total plaque volume (TPV). All results presented in the manuscript were derived from Cox Regression Models. Due to the rather low number of events, the Framingham Score was incorporated into the multivariate analysis to avoid model overfitting and adjust for overall cardiovascular risk factors.“Cantrell’s pentalogy”- Angiographic CT evaluation
A 36 year old pregnant was send to us from a pacific coast hospital. By c-section a full term male newborn was delivered, with a total cardiac exposure through an anterior thoracic wall defect (Fig. 1). At the time of delivery no cyanosis was identified. A non-gated 128- slice tomography angiography (CTA) showed: Ectopia corids, levocardia with levoapex, concordant atrioventricular and ventriculoatrial connections, side-by-side aorta and pulmonary artery (PA). Hypoplastic aortic root and ascending aorta.Simple cough presentation of a rare variant of a meandering left pulmonary vein
A 17-year-old female presenting to respiratory clinic with 4 months history of mild cough. Her physical examination is unremarkable. A chest radiograph showed a left-sided peri-hilar high-density tubular structure, thought to be a vascular malformation (Fig. 1). A computed tomography pulmonary angiogram (CTPA) revealed an unusual venous drainage of the left lung. The tubular structure was a meandering unilateral single pulmonary vein draining the left upper-lobe (Fig. 2a) then tortuously descending to cross the oblique fissure and join the left lower-lobe pulmonary vein before directly merging into the left side of the left atrium (Fig.Submillisievert CT angiography for carotid arteries using wide array CT scanner and latest iterative reconstruction algorithm in comparison with previous generations technologies: Feasibility and diagnostic accuracy
To assess evaluability and diagnostic accuracy of a low dose CT angiography (CTA) protocol for carotid arteries using latest Iterative Reconstruction (IR) algorithm in comparison with standard 100 kVp protocol using previous generation CT and IR.More than an atrial septal defect
A 49 year-old man was referred to our cardiology clinic because of an atrial septal defect (ASD) with left-to-right shunt and severe right chambers dilation detected on a transthoracic echocardiogram. The patient was asymptomatic and physical examination was unremarkable. A transoesophageal echocardiogram showed signs of an anomalous pulmonary venous drainage (APVD), so an angio-computed tomography was performed which confirmed the severe right chambers dilation (Fig. 1) and showed an ASD at the postero-superior portion of the interatrial septum compatible with a sinus venosus defect (Fig.Estimation of myocardial fibrosis in humans with dual energy CT
Myocardial fibrosis is present in a wide range of cardiac disorders. Its noninvasive detection presently relies on cardiac magnetic resonance (CMR), which may not be feasible in many patients. This work, building on prior work in phantoms and a small animal model, evaluated a novel method of analyzing non-contrast DECT images to estimate myocardial fibrosis in a prospectively-enrolled cohort of patients with varying severity of diffuse and localized fibrosis. Good agreement was demonstrated between DECT-based estimates and CMR markers of fibrosis and extracellular expansion, supporting potential utility and further studies of this technique in patients with myocardial disease.Vanished into thin air - Morgagni hernia producing echo artifact and diagnosed by cardiac CT
An 82-year-old woman presented with aphasia and right sided weakness and was diagnosed with an acute stroke. She was unable to undergo an MRI due to a cochlear implant but received thrombolytics for suspected large vessel occlusion. A carotid CT angiogram did not show significant stenosis. She underwent a transthoracic echocardiogram (TTE) to rule out a potential cardiac etiology. TTE windows were challenging [Panel A, Parasternal long axis view (PLAX). Panel B, Short axis view (SAX), Movie 1]. Subcostal views were only marginally better.
