Crown years for non-invasive cardiovascular imaging (Part IV): 30 years of cardiac computed tomography

Background: The myocardial mass at risk (MMAR), representing volume of myocardium distal to culprit lesion, is one of important factors for predicting adverse cardiac event in ischemic heart disease. However, current non-invasive cardiac imaging fails to quantify MMAR in patients with stable coronary artery disease. We have developed a new software calculating MMAR of any designated coronary artery by reconstructing the 3-dimensional-volume-data of cardiac computed tomography (CCT). The novel index, ratio of MMAR to whole left ventricular volume (%LV-MMAR), calculated with this software would be appealing to obtain MMAR objectively. This study aims to compare the %LV-MMAR with Bypass Angioplasty Revascularization Investigation (BARI) and modified Albert Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) scores, both of which are invasive angiographic methods widely used to estimate MMAR, in patients with single-vessel disease. Methods: Between April 2008 and March 2014, patients suspected of effort angina pectoris without history of previous myocardial infarction were assessed with CCT and invasive coronary angiography. Of those, 48 patients who were revealed single-vessel disease (left anterior descending artery (LAD): n=22, left circumflex artery (LCX): n=11 and right coronary artery (RCA): n=15) were included in this study. %LV-MMAR was calculated on the software. BARI and modified APPROACH score were calculated and compared with %LV-MMAR. Results: Mean %LV-MMAR was 27.6 [18.2-37.1] %. BARI and APPROACH scores showed a significant correlation (r=0.92, p<0.0001). Also, a significant correlation was observed between %LV-MMAR versus BARI and %LV-MMAR versus APPROACH (r=0.95, p<0.0001 and r=0.9, p<0.0001, respectively). %LV-MMAR showed significant correlation with BARI and APPROACH scores in all vessels; LAD (r=0.95, p<0.0001 and r=0.91, p<0.0001, respectively), LCX (r=0.91, p=0.0001 and r=0.83, p=0.0002, respectively) and RCA (r=0.92, p<0.0001 and r=0.85, p<0.0001, respectively). Conclusions: This study revealed %LV-MMAR, calculated from CCT data on novel software, to be a promising index for estimating perfusion territory noninvasively in good agreement with BARI and modified APPROACH score.

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Artificial intelligence in medical imaging: A radiomic guide to precision phenotyping of cardiovascular disease

Cardiovascular Research ◽

10.1093/cvr/cvaa021 ◽

2020 ◽

Vol 116 (13) ◽

pp. 2040-2054 ◽

Cited By ~ 5

Author(s):

Evangelos K Oikonomou ◽

Musib Siddique ◽

Charalambos Antoniades

Keyword(s):

Artificial Intelligence ◽

Cardiovascular Disease ◽

Computational Models ◽

Cardiac Computed Tomography ◽

Clinical Care ◽

Cardiovascular Imaging ◽

Current Status ◽

Current Evidence ◽

Scientific Validity ◽

Non Invasive

Abstract Rapid technological advances in non-invasive imaging, coupled with the availability of large data sets and the expansion of computational models and power, have revolutionized the role of imaging in medicine. Non-invasive imaging is the pillar of modern cardiovascular diagnostics, with modalities such as cardiac computed tomography (CT) now recognized as first-line options for cardiovascular risk stratification and the assessment of stable or even unstable patients. To date, cardiovascular imaging has lagged behind other fields, such as oncology, in the clinical translational of artificial intelligence (AI)-based approaches. We hereby review the current status of AI in non-invasive cardiovascular imaging, using cardiac CT as a running example of how novel machine learning (ML)-based radiomic approaches can improve clinical care. The integration of ML, deep learning, and radiomic methods has revealed direct links between tissue imaging phenotyping and tissue biology, with important clinical implications. More specifically, we discuss the current evidence, strengths, limitations, and future directions for AI in cardiac imaging and CT, as well as lessons that can be learned from other areas. Finally, we propose a scientific framework in order to ensure the clinical and scientific validity of future studies in this novel, yet highly promising field. Still in its infancy, AI-based cardiovascular imaging has a lot to offer to both the patients and their doctors as it catalyzes the transition towards a more precise phenotyping of cardiovascular disease.

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CASE REPORT OF AN ACUTE CORONARY SYNDROME IN A PATIENT WITH ARTERY CORONARY FISTULAE

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab323 ◽

2021 ◽

Author(s):

María José Romero-Castro ◽

Leire Unzué ◽

Eulogio García ◽

Leticia Fernández-Friera

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Cardiac Ct ◽

Cardiac Computed Tomography ◽

Accurate Diagnosis ◽

Percutaneous Closure ◽

Coronary Syndrome ◽

Non Invasive ◽

Case Summary ◽

Coronary Fistulae

Abstract Background Coronary artery fistulae are rare vascular anomalies. Although they are usually asymptomatic, the presence of symptoms might suppose a challenge in the diagnostic and therapeutic management. Case summary we present a patient with chest pain, all the initial tests were normal, but coronary artery fistulae were found. SPECT test showed ischemia due to coronary artery fistulae and cardiac CT helped in the planning of the percutaneous closure. Discussion Cardiac computed tomography (CCT) is an emerging optimal non-invasive tool to characterize their morphology and course, resulting essential for accurate diagnosis and eventually, planning the percutaneous closure.

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Comparison of transthoracic echocardiography with computed tomography in evaluation of pulmonary veins

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-01272-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Qing-Qing Dong ◽

Wen-Yi Yang ◽

Ya-Ping Sun ◽

Qian Zhang ◽

Guang Chu ◽

...

Keyword(s):

Computed Tomography ◽

Atrial Fibrillation ◽

Transthoracic Echocardiography ◽

Anatomic Variation ◽

Cardiac Computed Tomography ◽

Pulmonary Veins ◽

Non Invasive ◽

Clear Identification ◽

The Right

Abstract Background Transesophageal echocardiography may be used to assess pulmonary veins for atrial fibrillation ablation. No study focused on the role of transthoracic echocardiography (TTE) in evaluating the diameter and anatomy of pulmonary veins. Methods Among 142 atrial fibrillation patients (57.7% men; mean age, 60.5) hospitalised for catheter ablation, we assessed pulmonary veins and compared the measurements by TTE with cardiac computed tomography (CT) before ablation. Among 17 patients who had follow-up examinations, the second measurements were also studied. Results TTE identified and determined the diameters of 140 (98.6%) right and 140 (98.6%) left superior PVs, and 136 (95.7%) right and 135 (95.1%) left inferior PVs. A separate middle PV ostia was identified in 14 out of the 22 patients (63.6%) for the right side and in 2 out of 4 (50.0%) for the left side. The PV diameters before ablation assessed by CT vs. TTE were 17.96 vs. 18.07 mm for right superior, 15.92 vs. 15.51 mm for right inferior, 18.54 vs. 18.42 mm for left superior, and 15.56 vs. 15.45 mm for left inferior vein. The paired differences between the assessments of CT and TTE were not significant (P ≥ 0.31) except for the right inferior vein with a CT-minus-TTE difference of 0.41 mm (P = 0.018). The follow-up PV diameters by both CT (P ≥ 0.069) and TTE (P ≥ 0.093) were not different from baseline measurements in the 17 patients who had follow-up measurements. Conclusions With a better understanding of PV anatomy in TTE imaging, assessing PV diameters by non-invasive TTE is feasible. However, the clear identification of anatomic variation might still be challenging.

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