scholarly journals Complementary Diagnostic and Prognostic Contributions of Cardiac Computed Tomography for Infective Endocarditis Surgery

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Mnahi Bin Saeedan ◽  
Nicholas Chan ◽  
Nancy A. Obuchowski ◽  
Nabin Shrestha ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Cleveland Clinic ◽  
Total Mortality ◽  
Adverse Outcomes ◽  
Imaging Biomarker ◽  
Imaging Biomarkers ◽  
Contrast Enhanced Ct

Background: Cardiac computed tomography (CT) is emerging as an adjunctive modality to echocardiography in the evaluation of infective endocarditis (IE) and surgical planning. CT studies in IE have, however, focused on its diagnostic rather than prognostic utility, the latter of which is important in high-risk diseases like IE. We evaluated the associations between cardiac CT and transesophageal echocardiography (TEE) findings and adverse outcomes after IE surgery. Methods: Of 833 consecutive patients with surgically proven IE during May 1, 2014 to May 1, 2019, at Cleveland Clinic, 155 underwent both preoperative ECG-gated contrast-enhanced CT and TEE. Multivariable analyses were performed to identify CT and TEE biomarkers that predict adverse outcomes after IE surgery, adjusting for EuroSCORE II (European System for Cardiac operative Risk Evaluation II). Results: CT and TEE were positive for IE in 123 (75.0%) and 124 (75.6%) of patients, respectively. Thirty-day mortality occurred in 3 (1.9%) patients and composite mortality or morbidities in 72 (46.5%). Pseudoaneurysm or abscess detected on TEE was the only imaging biomarker to show independent association with composite mortality or morbidities in-hospital, with odds ratio (95% CI) of 3.66 (1.76–7.59), P =0.001. There were 17 late deaths, and both pseudoaneurysm or abscess detected on CT and fistula detected on CT were the only independent predictors of total mortality during follow-up, with hazards ratios (95% CI) of 3.82 (1.25–11.7), P <0.001 and 9.84 (1.89–51.0), P =0.007, respectively. Conclusions: We identified cardiac CT and TEE features that predicted separate adverse outcomes after IE surgery. Imaging biomarkers can play important roles incremental to conventional clinical factors for risk stratification in patients undergoing IE surgery.

Abstract 12719: Diagnostic and Prognostic Contributions of Cardiac Computed Tomography for Infective Endocarditis Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Mnahi Bin Saeedan ◽  
Nicholas Chan ◽  
Nancy Obuchowski ◽  
Nabin Shrestha ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Cleveland Clinic ◽  
Total Mortality ◽  
Adverse Outcomes ◽  
Imaging Biomarker ◽  
Imaging Biomarkers ◽  
Contrast Enhanced Ct

Background: Cardiac computed tomography (CT) is emerging as an adjunctive modality to echocardiography in the evaluation of infective endocarditis (IE) and surgical planning. CT studies in IE have, however, focused on its diagnostic rather than prognostic utility, the latter of which is important in high-risk diseases like IE. We evaluated the associations between cardiac CT and transesophageal echocardiography (TEE) findings and adverse outcomes after IE surgery. Methods: Of 833 consecutive patients with surgically proven IE during 5/1/2014-5/1/2019 at Cleveland Clinic, 155 underwent both pre-operative ECG-gated contrast-enhanced CT and TEE. Multivariable analyses were performed to identify CT and TEE biomarkers that predict adverse outcomes after IE surgery, adjusting for EuroSCORE II. Results: CT and TEE were positive for IE in 123 (75.0%) and 124 (75.6%) of patients respectively. CT identified an additional 11% of vegetations, 13% of pseudoaneurysms or abscesses, 5% of dehiscences and 14% of fistulae when TEE was negative. Thirty-day mortality occurred in 3 (1.9%) patients, and composite mortality and/or morbidities in 72 (46.5%). Pseudoaneurysm or abscess detected on TEE was the only imaging biomarker to show independent association with composite mortality and/or morbidities in-hospital, with odds ratio (95%CI) of 3.66 (1.76-7.59), P=0.001. There were 17 late deaths, and both pseudoaneurysm or abscess detected on CT and fistula detected on CT were the only independent predictors of total mortality during follow-up, with hazards ratios (95%CI) of 3.82 (1.25, 11.7), P<0.001 and 9.84 (1.89, 51.0), P=0.007 respectively (Figure). Conclusion: We identified cardiac CT and TEE features that predicted separate adverse outcomes after IE surgery. Imaging biomarkers can play important roles incremental to conventional clinical factors for risk stratification in patients undergoing IE surgery.

Cardiac computed tomography in the contemporary evaluation of infective endocarditis

2021 ◽  
Author(s):  
Omar K. Khalique ◽  
Mahdi Veillet-Chowdhury ◽  
Andrew D. Choi ◽  
Gudrun Feuchtner ◽  
Juan Lopez-Mattei
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Cardiac Computed Tomography

Japanese multicenter registry evaluating the antegrade dissection reentry with cardiac computed tomography for chronic coronary total occlusion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Habara ◽  
E Tsuchikane ◽  
K Shimizu ◽  
T Kawasaki
Keyword(s):  
Computed Tomography ◽  
Success Rate ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Coronary Intervention ◽  
Puncture Site ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Failure Point ◽  
Procedural Success

Abstract Objective This study was performed to evaluate the efficacy of cardiac computed tomography (CT) for antegrade dissection re-entry (ADR) technique in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background Although PCI of CTO is a rapidly evolving field, procedure success rate remains suboptimal. Recently, ADR with Stingray device for CTO-PCI has also evolved to one of the pillar technique of the hybrid algorithm. Although the success rate of the device could be improved, it also remains not always high especially as first crossing strategy. Methods Forty eight patients with total occlusion suitable for revascularization evaluated by baseline coronary angiography and cardiac CT were enrolled in this study from April 2017 to April 2019 from 30 enrolled centers. The primary observation was procedural success. Furthermore, all puncture point with Stingray were analyzed by cardiac CT. In each point, 1) plaques on the isolated myocardial side at distal puncture site (+1 point), 2) any plaques excluded above definition at distal puncture site (+2 points), 3) calcification on both 1 and 2 at distal puncture site (+1 point) were analyzed and calculated the score (Score 0–3) (Figure 1). Results Overall procedure success rate was 95.8% (46/48) and antegrade success rate was 91.3% (42/46). Sixteen cases were succeeded with single guidewire escalation and 32 cases were attempted ADR with Stingray system. Within them, 25 cases were succeeded and 7 cases were observed puncture failure. And 3cases were succeeded with IVUS guide and 2 cases were with retrograde appTechnical success rate with stingray was 78.1% (25/32). Cardiac CT was analyzed 60 puncture sites in 32 cases which were attempted ADR with stingray system (1.88 sites/case). CT score at ADR success point was significantly smaller compare to that at ADR failure point (0.68±1.09 vs 1.77±1.09, p&lt;0.0001). Conclusions Pre procedure Cardiac CT and CT score might be useful for ADR technique in CTO PCI not only for case selection but also for puncture site selection. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Comparing the diagnostic accuracy of computed tomography vs transoesophageal echocardiography for infective endocarditis − A meta-analysis

2022 ◽  
Vol 38 (3) ◽  
Author(s):  
Liqin Jing ◽  
Yanchun Song
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Diagnostic Accuracy ◽  
English Language ◽  
Cardiac Computed Tomography ◽  
Meta Analysis ◽  
Transoesophageal Echocardiography ◽  
Cochrane Central Register ◽  
Index Test ◽  
Creative Commons

Objective: To investigate the comparative diagnostic accuracy of cardiac computed tomography (CT) and transoesophageal echocardiography (TEE) for detecting infective endocarditis. Methods: Original publications published in English language before July, 2021 were thoroughly search in PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar literature databases. Studies were included if they used CT and/or TEE as an index test, presented data on valvular complications related to infective endocarditis, and used surgical findings as to the reference standard. Results:­­­ Literature screening identified fifteen studies that fulfilled the inclusion criteria. Meta-analysis showed that CT sensitivity for detecting valvular abscesses was higher than that of TEE [0.88 (95% confidence interval [CI]: 0.82 to 0.94; 11 studies involving 842 subjects) versus 0.74 (95% CI: 0.65 to 0.84) P = 0.015; 12 studies involving 917 subjects]. TEE showed statistically significantly greater sensitivity than CT for detecting valvular vegetation [0.91 (95% CI: 0.84 to 0.97, 11 studies involving 971 subjects) versus 0.80 (95% CI: 0.69 to 0.82), 12 studies involving 915 subjects, P =0.019. In case of leaflet detection, TEE showed statistically significantly higher sensitivity than CT (0.76 vs 0.46, P =0.010). Conclusion: CT performs statistically significantly better than TEE for detecting abscesses while TEE provides statistically significant superior results for detecting vegetation. There is a need for well-designed prospective studies to further corroborate these findings. doi: https://doi.org/10.12669/pjms.38.3.5139 How to cite this:Jing L, Song Y. Comparing the diagnostic accuracy of computed tomography vs transoesophageal echocardiography for infective endocarditis − A meta-analysis . Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5139 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

3255Characterization of the arrhythmogenic substrate with multimodality imaging in ischemic patients undergoing VT ablation: relationship between cardiac computed tomography and magnetic resonance

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Zucchelli ◽  
D Soto Iglesias ◽  
B Jauregui ◽  
C Teres ◽  
D Penela ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Cardiac Ct ◽  
Low Voltage ◽  
Multimodality Imaging ◽  
Cardiac Computed Tomography ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Arrhythmogenic Substrate

Abstract Background Cardiac magnetic resonance (CMR)-aided ventricular tachycardia (VT) substrate ablation has shown to improve VT recurrence-free survival, through a better identification of the arrhythmogenic substrate. However, the access to CMR may be limited in certain centers or sometimes Its use can be contraindicated in patients with cardiac implantable electronic device. Cardiac computed tomography (CT) has shown to improve the results of substrate ablation, correlating with low-voltage areas and local abnormal ventricular activity, and identifying ridges of myocardial tissue (CT-channels) that may be appropriate target sites for ablation. Purpose To evaluate the correlation between CT and CMR imaging in identifying anatomical heterogeneous tissue channels (CMR-channels) or CT-channels in ischemic patients undergoing VT substrate ablation. Methods The study included 30 post-myocardial infarction (MI) patients (mean age 69±10; 94% male, left ventricular ejection fraction 35±10%), who underwent both CMR and cardiac CT before VT substrate ablation. Using a dedicated post-processing software, the myocardium was segmented in 10 layers from endocardium to epicardium both for the CMR and CT, characterizing the presence of CMR-channels and CT-channels, respectively, by two blinded operators, assigned either to CMR or CT analysis. CMR-channels were classified as endocardial (CMR-channels in layer <50%), epicardial (CMR-channels in layers ≥50%) or transmural (in both endo and epicardial layers). Presence and location of CT and CMR-channels were compared. Results In 26/30 patients (86.7%) 91 CT-channels (mean 3.0±1.9 per patient) were identified while 30/30 (100%) showed CMR-channels (n=76; mean 2.4±1.2 per patient). We found 190 CT-channel entrances (mean 6.3±4.1 per patient), and 275 CMR-channel entrances (mean 8.9±4.9 per patient) on cardiac CT and CMR, respectively. There were 47/91 (51.6%) true positive CT-channels. On the contrary, 44/91 (48.4%) CT-channels were considered false positives [19/91 (20.9%) identified out of CMR scar], and 29/76 (38.2%) CMR-channels could not be identified on CT. Thirty-six out of 76 (47.4%) CMR-channels were considered as non-endocardial (epi- or transmural). Twenty-nine out of 36 (80.5%) non-endocardial CMR-channels were coincident with CT-channels. CT and CMR Channels Conclusion CT shows a modest sensitivity in identifying CMR-channels and fails in ascertain their complexity, underestimating the number of entrances; however, channels location at CT fit well with CMR for those classified as transmural or epicardial.

scholarly journals Comparison of epicardial adipose tissue volume quantification between cardiac and chest computed tomography scans

2020 ◽  
Author(s):  
Lingyu Xu ◽  
Yuancheng Xu ◽  
Stanislau Hrybouski ◽  
D Ian Paterson ◽  
Richard B. Thompson ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Adipose Tissue ◽  
Cardiac Ct ◽  
Epicardial Adipose Tissue ◽  
Hounsfield Unit ◽  
Chest Ct ◽  
Strongly Correlated ◽  
Imaging Protocol ◽  
Chest Computed Tomography ◽  
Contrast Enhanced Ct

ABSTRACTBackgroundThis study investigated accuracy and consistency of epicardial adipose tissue (EAT) quantification in chest computed tomography (CT) scans.Methods and resultsEAT volume was quantified semi-automatically using a standard Hounsfield unit threshold (-190U, -30) in three independent cohorts: (1) Cohort 1 (N = 30) consisted of paired 120 KV cardiac non-contrast CT (NCCT) and 120 KV chest NCCT; (2) Cohort 2 (N = 20) consisted of paired 120 KV cardiac NCCT and 100 KV chest NCCT; (3) Cohort 3 (N = 20) consisted of paired chest NCCT and chest contrast-enhanced CT (CECT) datasets. Images were reconstructed with the slice thicknesses of 1.25 mm and 5 mm in the chest CT datasets, and 3 mm in the cardiac NCCT datasets. In Cohort 1, the chest NCCT-1.25 mm EAT volume was similar to the cardiac NCCT EAT volume, whilst chest NCCT-5 mm underestimated the EAT volume by 7.0%. In Cohort 2, 100 KV chest NCCT-1.25mm and -5 mm EAT volumes were 9.7% and 6.4% larger than corresponding 120 KV cardiac NCCT EAT volumes. In Cohort 3, the chest CECT dataset underestimated EAT volumes by ∼25%, relative to chest NCCT datasets. All chest CT-derived EAT volumes were strongly correlated with their cardiac CT counterparts.ConclusionsThe chest NCCT-1.25 mm EAT volume with the 120 KV tube energy produced EAT volumes that are comparable to cardiac NCCT. All chest CT EAT volumes were strongly correlated with EAT volumes obtained from cardiac CT, if imaging protocol is consistently applied to all participants.

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

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.

scholarly journals Predictors of Spontaneous Echocardiographic Contrast Within the Left Atrial Appendage in Cardiac Computed Tomography of Patients with Atrial Fibrillation

2021 ◽  
Author(s):  
Kotaro Ouchi ◽  
Toru Sakuma ◽  
Takahiro Higuchi ◽  
Jun Yoshida ◽  
Ryosuke Narui ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cardiac Ct ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Atrial Appendage ◽  
Receiver Operator Characteristic

Abstract PurposeCardiac computed tomography (CT) depiction of the relationship between spontaneous echocardiographic contrast (SEC) and findings of the left atrial appendage (LAA) has not been reported. We evaluated predictors of SEC within the LAA using findings of cardiac CT in patients with atrial fibrillation (AF).MethodsWe retrospectively analyzed cardiac CT findings of the LAA, including morphology, volume, and filling defects, of 641 patients who underwent Transesophageal echocardiography (TEE) prior to pulmonary vein isolation (PVI) from January 6, 2013 through December 16, 2019 at our institution. We investigated potential associated factors that might be predictors of SEC and computed a receiver operator characteristic,choosing a threshold value at which the likelihood of SEC could be predicted based on the LAA volume indexed for body size.ResultsSEC correlated significantly with history of persistent AF (P<0.001; odds ratio [OR], 3.74; 95% confidence interval [CI], 1.91–7.29), LAA early filling defects (P =0.003; OR, 2.83; 95% CI, 1.43–5.62), LAAFV (P<0.001; OR, 0.97; 95% CI, 0.96–0.99), and indexed LAA volume (P = 0.001; OR, 1.18; 95% CI, 1.07–1.30) of 8.04 cm3/m2 or greater (sensitivity, 75.0%; specificity, 48.7%).The addition of LAAFV to indexed LAA volume increased the area under the receiver operator characteristic curve from 0.642 to 0.724 (P< 0.001).ConclusionFindings of LAA in cardiac CT might allow the noninvasive estimation of SEC and additional information for risk stratification and management of thromboembolic events in patients with AF.

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