Interventional imaging – a modern Telemacheia

Abstract BACKGROUND There is conflicting data on early left ventricle (LV) remodeling in diabetes mellitus (DM) and hypertension (HTN). This study examines the feasibility of cardiac computed tomography angiography (CCTA) to detect early LV geometric changes in patients with DM and HTN. METHODS Consecutive patients (n = 5,992) who underwent prospective electrocardiography (ECG)-triggered (mid-diastolic) CCTA were screened. Patients with known structural heart disease or known LV dysfunction were excluded. Left ventricular mass (LVM), left ventricular mid-diastolic volume (LVMDV), and LV concentricity (LVM/LVMDV) were measured and indexed to body surface area. RESULTS A total of 4,283 patients were analyzed (mean age 57 ± 10.69 years, female 46.7%). DM, HTN, and HTN + DM were present in 4.1%, 35.8% and 10.6% of patients, respectively. Compared to normal patients, HTN and HTN + DM patients had increased LVM indexed to body surface area (LVMi) (56.87 ± 17.24, 59.26 ± 13.62, and 58.56 ± 13.09, respectively; P < 0.05). There was no difference in LVMi between normal subjects and patients with DM (56.39 ± 11.50, P = 0.617). Concentricity indices were higher in patient with HTN (1.0456 ± 0.417; P < 0.001), DM (1.109 ± 0.638; P = 0.004), and HTN + DM (1.083 ± 0.311, P < 0.001) than normal individuals (0.9671 ± 0.361). There was no overlap of the 95% confidence intervals in the composite of concentricity indices and LVMi between the different groups. CONCLUSIONS CCTA measures of LVM and concentricity index may discriminate patients with HTN and DM before overt structural heart disease.

Download Full-text

Computed tomography for cardiac interventions

ESC CardioMed ◽

10.1093/med/9780198784906.003.0118_update_001 ◽

2018 ◽

pp. 565-572

Author(s):

Mohamed Marwan ◽

Stephan Achenbach

Keyword(s):

Computed Tomography ◽

Heart Disease ◽

Cardiac Ct ◽

Structural Heart Disease ◽

Interventional Imaging ◽

Contrast Enhanced ◽

And Performance ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Pre-procedural imaging is essential for successful planning and performance of several cardiac interventions. For this purpose, contrast-enhanced computed tomography (CT) imaging—owing to its high and isotropic spatial resolution as well as fast volume coverage—is gaining increasing importance. Cardiac CT offers high-resolution morphological and functional imaging of cardiac structures which is valuable for a variety of structural heart disease interventions, electrophysiology procedures, and coronary interventions. Over the last decade, the widened spectrum of transcatheter cardiac interventions has been associated with widespread acknowledgment that CT is particularly useful for pre-interventional imaging and increasing implementation in clinical routine. In this chapter, the role of cardiac CT for the guidance of coronary as well as non-coronary cardiac interventions is described.

Download Full-text

Computed tomography for cardiac interventions

ESC CardioMed ◽

10.1093/med/9780198784906.003.0118 ◽

2018 ◽

pp. 565-572

Author(s):

Mohamed Marwan ◽

Stephan Achenbach

Keyword(s):

Computed Tomography ◽

Heart Disease ◽

Cardiac Ct ◽

Structural Heart Disease ◽

Interventional Imaging ◽

Contrast Enhanced ◽

And Performance ◽

Enhanced Computed Tomography ◽

Contrast Enhanced Computed Tomography

Pre-procedural imaging is essential for successful planning and performance of several cardiac interventions. For this purpose, contrast-enhanced computed tomography (CT) imaging—owing to its high and isotropic spatial resolution as well as fast volume coverage—is gaining increasing importance. Cardiac CT offers high-resolution morphological and functional imaging of cardiac structures which is valuable for a variety of structural heart disease interventions, electrophysiology procedures, and coronary interventions. Over the last decade, the widened spectrum of transcatheter cardiac interventions has been associated with widespread acknowledgment that CT is particularly useful for pre-interventional imaging and increasing implementation in clinical routine. In this chapter, the role of cardiac CT for the guidance of coronary as well as non-coronary cardiac interventions is described.

Download Full-text

Diagnostic Impact of Repeated Expert Review & Long‐Term Follow‐Up in Determining Etiology of Idiopathic Cardiac Arrest

Journal of the American Heart Association ◽

10.1161/jaha.120.019610 ◽

2021 ◽

Author(s):

Ahmed Merghani ◽

Christopher Monkhouse ◽

Claire Kirkby ◽

Konstantinos Savvatis ◽

Saidi A. Mohiddin ◽

...

Keyword(s):

Cardiac Arrest ◽

Heart Disease ◽

Multidisciplinary Team ◽

Significant Proportion ◽

Structural Heart Disease ◽

Implantable Cardioverter Defibrillators ◽

Normal Heart ◽

Team Meetings ◽

Multidisciplinary Team Meetings

Background Recognizing the etiology of sudden cardiac arrest (SCA) has an enormous impact on the management of victims and their immediate families. A significant proportion of SCA survivors with a structurally normal heart are not offered a diagnosis and there is no clear consensus on the type and duration of follow‐up. We aimed to assess the utility of a multidisciplinary approach in optimizing diagnosis of cardiac arrest etiology during follow‐up. Methods and Results We retrospectively assessed 327 consecutive SCA survivors (mean age 61.9±16.2 years, 80% men) who underwent secondary prevention implantable cardioverter defibrillators between May 2015 and November 2018. The initial diagnosis was recorded at the time of admission and follow‐up diagnosis was deduced from subsequent clinic records, investigations, and outcomes of multidisciplinary team meetings. Structural heart disease accounted for 282 (86%) of SCAs. Forty‐five (14%) patients had a structurally normal heart and underwent comprehensive testing and follow‐up (mean duration 93±52 weeks). On initial evaluation, 14/45 (31%) of these received a diagnosis, rising to 29/45 (64%) with serial reviews during follow‐up. Discussion in multidisciplinary team meetings and imaging reassessment accounted for 47% of new diagnoses. No additional diagnoses were made beyond 96 weeks. Nineteen (5.8%) fatalities occurred in the entire cohort, exclusively in patients with structural heart disease. Conclusions Systematic comprehensive testing combined with multidisciplinary expert team review of SCA survivors without structural heart disease improves the yield and time to diagnosis compared with previously published studies. This approach has positive implications in the management of SCA survivors and their families.

Download Full-text

Faculty Opinions recommendation of Can cardiac computed tomography predict cardiovascular events in asymptomatic type-2 diabetics?: results of a long term follow-up.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718233211.793510535 ◽

2015 ◽

Author(s):

Nathan Wong

Keyword(s):

Computed Tomography ◽

Cardiovascular Events ◽

Cardiac Computed Tomography ◽

Type 2 Diabetics ◽

Long Term Follow Up

Download Full-text

Two hearts, one soul: heterotopic heart transplantation follow-up with cardiac computed tomography

European Heart Journal ◽

10.1093/eurheartj/ehw288 ◽

2016 ◽

Vol 37 (44) ◽

pp. 3356-3356 ◽

Cited By ~ 2

Author(s):

Charles Roux ◽

Shaida Varnous ◽

Pascal Leprince ◽

Philippe Cluzel

Keyword(s):

Computed Tomography ◽

Heart Transplantation ◽

Cardiac Computed Tomography ◽

Heterotopic Heart Transplantation

Download Full-text

Abstract 11726: Novel Non-Invasive Method to Estimate Myocardial Mass at Risk Calculated From Cardiac Computed Tomography Data: Validation Study Using Angiographic Myocardial Jeopardy Scores in Patients With Single Vessel Disease

Circulation ◽

10.1161/circ.130.suppl_2.11726 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Seiko IDE ◽

Satoru Sumitsuji ◽

Kensuke Yokoi ◽

Masatoki Yoshida ◽

Isamu Mizote ◽

...

Keyword(s):

Computed Tomography ◽

At Risk ◽

Heart Disease ◽

Coronary Artery ◽

Cardiac Computed Tomography ◽

Myocardial Mass ◽

Non Invasive ◽

Vessel Disease ◽

Single Vessel ◽

Single Vessel Disease

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.

Download Full-text

The Changing Paradigm in the Treatment of Structural Heart Disease and the Need for the Interventional Imaging Specialist

Interventional Cardiology Review ◽

10.15420/icr.2016:12:2 ◽

2016 ◽

Vol 11 (2) ◽

pp. 135

Author(s):

Nina C Wunderlich ◽

Harald Küx ◽

Felix Kreidel ◽

Ralf Birkemeyer ◽

Robert J Siegel ◽

...

Keyword(s):

Heart Disease ◽

Heart Diseases ◽

Three Dimensional ◽

Structural Heart Disease ◽

Percutaneous Treatment ◽

Interventional Imaging ◽

Key Factor ◽

Structural Heart Diseases ◽

Specialist Standard ◽

Contrast Ventriculography

Percutaneous interventions in structural heart diseases are emerging rapidly. The variety of novel percutaneous treatment approaches and the increasing complexity of interventional procedures are associated with new challenges and demands on the imaging specialist. Standard catheterisation laboratory imaging modalities such as fluoroscopy and contrast ventriculography provide inadequate visualisation of the soft tissue or three-dimensional delineation of the heart. Consequently, additional advanced imaging technology is needed to diagnose and precisely identify structural heart diseases, to properly select patients for specific interventions and to support fluoroscopy in guiding procedures. As imaging expertise constitutes a key factor in the decision-making process and in the management of patients with structural heart disease, the sub-speciality of interventional imaging will likely develop out of an increased need for high-quality imaging.

Download Full-text