Dual energy imaging and intracycle motion correction for CT coronary angiography in patients with intermediate to high likelihood of coronary artery disease

We explored whether intracycle motion correction algorithms (MCAs) might be applicable to dual energy computed tomography coronary angiography in patients with intermediate to high likelihood of coronary artery disease. MCA reconstructions were associated with higher interpretability rates (96.7% vs 87.9%, P < .001), image quality scores (4.12±0.9 vs. 3.76±1.0; P < .0001), and diagnostic performance [area under the curve of 0.95 (95% confidence interval [CI] 0.92-0.97) vs 0.89 (95% CI 0.86-0.92); P < .0001] compared to conventional reconstructions. In conclusion, application of intracycle MCA reconstructions to dual energy computed tomography acquisitions was feasible and resulted in significantly higher image quality scores, interpretability, and diagnostic performance.Fil: Carrascosa, Patricia. Diagnóstico Maipú; ArgentinaFil: Deviggiano, Alejandro. Diagnóstico Maipú; ArgentinaFil: Leipsic, Jonathon A.. St. Paul's Hospital; CanadáFil: Capunay, Carlos. Diagnóstico Maipú; ArgentinaFil: De Zan, Macarena C.. Diagnóstico Maipú; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Diagnóstico Maipú; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentin

[Myocardial ischemia without coronary obstructions: MINOCA-INOCA. Review for decision making].

One in every four coronarographies performed to study myocardial ischemia shows coronary angiographic stenosis less than 50%. This data triggered an increasing interest in the medical community. The American Society of Cardiology recently published a position paper about the pathophysiology, diagnosis and treatment of this entity. Our group performed a narrative review reflecting the opinion of cardiology experts from different centers in Argentina. It aims physiopatologic and diagnostic aspect to understand the current approach in patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) e INOCA (demonstrated angina and ischemia but without coronary lesions that justify this syndrome)

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Reproducibility of Gadolinium Enhancement Patterns and Wall Thickness in Hypertrophic Cardiomyopathy

Abstract Background: Reproducibility data of the extent and patterns of late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) is limited. Objective: To explore the reproducibility of regional wall thickness (WT), LGE extent, and LGE patterns in patients with HCM assessed with cardiac magnetic resonance (CMR). Methods: The extent of LGE was assessed by the number of segments with LGE, and by the total LV mass with LGE (% LGE); and the pattern of LGE-CMR was defined for each segment. Results: A total of 42 patients (672 segments) with HCM constituted the study population. The mean WT measurements showed a mean difference between observers of -0.62 ± 1.0 mm (6.1%), with limits of agreement of 1.36 mm; -2.60 mm and intraclass correlation coefficient (ICC) of 0.95 (95% CI 0.93-0.96). Maximum WT measurements showed a mean difference between observers of -0.19 ± 0.8 mm (0.9%), with limits of agreement of 1.32 mm; -1.70 mm, and an ICC of 0.95 (95% CI 0.91-0.98). The % LGE showed a mean difference between observers of -1.17 ± 1.2 % (21%), with limits of agreement of 1.16%; -3.49%, and an ICC of 0.94 (95% CI 0.88-0.97). The mean difference between observers regarding the number of segments with LGE was -0.40 ± 0.45 segments (11%), with limits of agreement of 0.50 segments; -1.31 segments, and an ICC of 0.97 (95% CI 0.94-0.99). Conclusions: The number of segments with LGE might be more reproducible than the percent of the LV mass with LGE

Asociación entre patrones de llenado ventricular y extensión del realce tardío por resonancia magnética en pacientes con miocardiopatía hipertrófica

Objective To explore the relationship between ventricular filling curves and the extent of late enhancement on cardiac magnetic resonance imaging (MRI) in patients with hypertrophic cardiomyopathy. Material and methods We retrospectively included consecutive patients with suspected and/or confirmed hypertrophic cardiomyopathy and a control group of patients matched for age and sex who underwent cardiac MRI with evaluation of late enhancement. Among other determinations, we evaluated the following parameters on cine sequences: peak filling rate, time to the first peak filling rate, and filling rate normalized to the filling volume. Results Late enhancement was observed in 29 (73%) of the 40 patients with hypertrophic cardiomyopathy. The normalized peak filling rate was significantly lower in patients with late enhancement (4.9  ±  1.6 in those with hypertrophic cardiomyopathy positive for late enhancement vs. 5.8  ±  2.2 in those with hypertrophic cardiomyopathy negative for late enhancement vs. 6.3  ±  1.5 in controls, p  =  0.008) and the time to peak filling was longer in patients with late enhancement (540.6  ±  89.7 ms vs. 505.5  ±  99.3 ms in those with hypertrophic cardiomyopathy negative for late enhancement vs. 486.9  ±  86.3 ms in controls, p  =  0.02). When the population was stratified into three groups in function of the normalized peak filling rate, significant differences were observed among groups for age (p  =  0.002), mean wall thickness (p  =  0.036), and myocardial mass (p  =  0.046) and atrial dimensions, whereas no significant differences with respect to late enhancement were seen. Conclusions In patients with hypertrophic cardiomyopathy, we found a significant association between ventricular filling patterns and age, wall thicknesses, and atrial dimensions, but not with the extent of late enhancement.Objetivo Explorar mediante resonancia magnética cardíaca la relación entre las curvas de llenado ventricular y la extensión del realce tardío (RT) en pacientes con miocardiopatía hipertrófica. Material y métodos Se incluyeron de forma retrospectiva pacientes consecutivos con sospecha y/o diagnóstico de miocardiopatía hipertrófica, y un grupo control de pacientes pareados según sexo y edad en quienes se realizó una resonancia magnética cardíaca con valoración de RT. Entre otras determinaciones, se evaluaron mediante secuencias cine: tasa de llenado pico, tiempo a la primera tasa de llenado pico y tasa de llenado pico normalizada al volumen de llenado. Resultados De los 40 pacientes con miocardiopatía hipertrófica, 29 (73%) presentaron RT. Se evidenciaron diferencias significativas respecto a la tasa de llenado pico normalizada (RT positivo 4,9 ± 1,6, vs. RT negativo 5,8 ± 2,2, vs. control 6,3 ± 1,5, p = 0,008) y al tiempo a la tasa de llenado pico (540,6 ± 89,7 ms, vs. 505,5 ± 99,3 ms, vs. 486,9 ± 86,3 ms, p = 0,02). Al estratificar la población en tercios según la tasa de llenado pico normalizada al volumen de llenado se registraron diferencias significativas entre los grupos respecto a la edad (p = 0,002), espesor parietal medio (p = 0,036), masa miocárdica (p = 0,046) y dimensiones auriculares, mientras que no se observaron diferencias significativas respecto al RT. Conclusiones En pacientes con miocardiopatía hipertrófica encontramos una asociación significativa entre patrones de llenado ventricular y edad, espesores parietales y dimensiones auriculares, mientras que no se identificó una relación significativa con la extensión del RT.Fil: De Zan, M.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; ArgentinaFil: Carrascosa, P.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; ArgentinaFil: Deviggiano, A.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; ArgentinaFil: Capunay, C.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentin

Wall Thickness and Patterns of Fibrosis in Hypertrophic Cardiomyopathy Assessed by Cardiac Magnetic Resonance Imaging

Background: Hypertrophic cardiomyopathy is the most common genetic cardiac disease and the main cause of sudden death in theyoung. Cardiac magnetic resonance imaging can characterize the different forms of hypertrophic cardiomyopathy and detect myocardialfibrosis by late gadolinium enhancement.Objectives: The aim of this study was to characterize the regional distribution of left ventricular wall thickness and its relationwith myocardial fibrosis, and also quantify the percentage and determine the different patterns of left gadolinium enhancement inpatients with hypertrophic cardiomyopathy evaluated with cardiac magnetic resonance imaging.Methods: This observational study evaluated patients with hypertrophic cardiomyopathy undergoing contrast-enhanced cardiacmagnetic resonance imaging. The results were compared with a group of control patients. Hypertrophic cardiomyopathy morphologywas evaluated and the percentage of late gadolinium enhancement was determined.Results: Maximum wall thickness was observed in the mid inferoseptal (16.8±5.3 mm), basal anteroseptal (16.5±6.2 mm), and midanteroseptal segments (15.4±6.2 mm). Thirty patients (71%) with hypertrophic cardiomyopathy presented late gadolinium enhancementin 141/672 (21%) of the segments evaluated. Late gadolinium enhancement was predominantly intramyocardial (n=103,73%). A significant association was found between the percentage of late gadolinium enhancement in the left ventricle and maximummyocardial wall thickness.Conclusions: Maximum wall thickness was more frequently observed in the basal and mid septal segments. Two-thirds of thesepatients presented late gadolinium enhancement which was associated with maximum wall thicknessIntroducción: La miocardiopatía hipertrófica (MCH) es la enfermedad cardiovascular hereditaria más frecuente  y la principal causa de muerte súbita en los individuos jóvenes. La resonancia magnética cardíaca (RMC) permite  caracterizar  las distintas formas de MCH  y detectar  fibrosis miocárdica a través del realce tardío (RT). Objetivos: Caracterizar la distribución regional de los espesores miocárdicos y su relación con la  fibrosis miocárdica así como cuantificar el porcentaje  y determinar los diferentes patrones de RT en paciente con MCH evaluados por RMC. Materiales y métodos: El presente fue un estudio observacional que evaluó  pacientes con diagnóstico de MCH  a través de la RMC con contraste endovenoso. Los resultados se compararon con un grupo de pacientes control. Se efectuó la evaluación morfológica y se determinó  el porcentaje total de RT (% RT). Resultados: El espesor máximo de los pacientes con MCH se evidenció en el segmento inferoseptal medio 16.8±5.3 mm, seguido por los segmentos anteroseptal basal 16.5±6.2 mm y anteroseptal medial 15.4±6.2 mm. Presentaron RT 30 (71 %) pacientes con MCH y 141/672 (21 %) de los segmentos evaluados. La distribución del RT fue predominantemente intramiocárdica (n=103, 73%). Se encontró una relación significativa entre % RT del ventrículo izquierdo y el espesor miocárdico máximo. Conclusión: La localización más frecuente del espesor parietal máximo se encontró a nivel septal basal y medial. En dos tercios de estos pacientes se detectó RT, el cual se asoció al espesor miocárdico máximo

Substantial iodine volume load reduction in CT angiography with dual-energy imaging: insights from a pilot randomized study

We explored whether dual-energy computed tomography (DECT) can allow a significant reduction in iodinated contrast volume during computed tomography angiography (CTA) without hampering image quality or assessibility. We prospectively randomized patients clinically referred to CTA to single energy computed tomography (SECT) with full iodine volume load (group A), DECT with 50 % iodine volume load (group B), DECT with 40 % iodine volume load (group C), and DECT with 30 % iodine volume load (group D); and compared image quality and assessibility. Eighty patients were enrolled and prospectively randomized. The mean age was 61.7 ± 15.0 years and 56 (71 %) patients were male. The demographical characteristics, body mass index, or mean radiation dose did not differ between groups. Significant reductions in total contrast volume were achieved in groups B, C, and D; with mean administrated contrast volumes of 90.3 ± 10.1, 39.5 ± 4.6, 28.3 ± 6.5, and 23.9 ± 6.0 mL, respectively, in groups A to D (p < 0.0001). With regard to image quality, no significant decrease in the Likert scale was observed with reductions of up to 60 % of the contrast volume (groups B and C). DECT at 50–60 keV in association with up to 60 % iodine load reduction, allowed similar signal density, image noise, and signal to noise ratio that SECT imaging with full iodine load. In this pilot, prospective, randomized study, dual energy CTA with up to 60 % iodine volume load reduction provided similar image quality and assessibility than full iodine load with conventional SECT imaging.Fil: Carrascosa, Patricia. Diagnostico Maipu; ArgentinaFil: Capunay, Carlos. Diagnostico Maipu; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Diagnostico Maipu; ArgentinaFil: Deviggiano, Alejandro. Diagnostico Maipu; ArgentinaFil: Vallejos, Javier. Diagnostico Maipu; ArgentinaFil: Leipsic, Jonathon A.. St. Paul’s Hospital; Canad

Monochromatic image reconstruction by dual energy imaging allows half iodine load computed tomography coronary angiography

Purpose: To compare image interpretability and diagnostic performance of dual-energy CT coronary angiography (DE-CTCA) performed with 50% iodine load reduction versus single energy acquisitions (SE-CTCA) with full iodine load. Materials and methods: The present prospective study involved patients with suspected coronary artery disease (CAD) clinically referred for CTCA. DE-CTCA with 50% iodine volume load was performed first, and after heart rate returned to baseline SE-CTCA was performed using full iodine volume load. The primary endpoint was to compare image interpretability between groups. DE-CTCA was performed by rapid switching between low and high tube potentials (80–140 kV) from a single source, allowing the generation of monochromatic image reconstructions ranging from 40 to 140 keV. Image quality assessment was performed using a 5-point Likert scale. Results: Thirty-six patients constituted the study population. The mean heart rate before the CT scan (DE-CTCA 57.3 ± 10.7 bpm vs. SE-CTCA 58.5 ± 11.2 bpm, p = 0.29) and the mean effective radiation dose (3.5 ± 1.9 mSv vs. 3.8 ± 0.9 mSv, p = 0.48) did not differ between groups. Likert image quality scores were similar between groups (DE-CTCA 4.42 ± 0.98 vs. SE-CTCA 4.43 ± 0.84, p = 0.67). Signal-to-noise and contrast-to-noise ratios were significantly lower with DE-CTCA, driven by lower signal density levels at 60 keV compared to SE-CTCA. The sensitivity and specificity for the detection of stenosis >50% was indistinguishable between groups (DE-CTCA 84.4% (69.9–93.0%), 87.1% (81.6–91.2%); SE-CTCA 84.4% (69.9–93.0%), 87.1% (81.6–91.2%). Conclusions: In this pilot, prospective study, dual energy CTCA imaging with half iodine load achieved comparable interpretability than full iodine load with single energy CTCA.Fil: Carrascosa, Patricia. Diagnostico Maipu; ArgentinaFil: Leipsic, Jonathon A.. St. Paul's Hospital; CanadáFil: Capunay, Carlos. Diagnostico Maipu; ArgentinaFil: Deviggiano, Alejandro. Diagnostico Maipu; ArgentinaFil: Vallejos, Javier. Diagnostico Maipu; ArgentinaFil: Goldsmit, Alejandro. Sanatorio Güemes; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Diagnostico Maipu; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin