The effect of iterative model reconstruction on coronary artery calcium quantification

Coronary artery calcium (CAC) scoring with computed tomography (CT) is an established tool for quantifying calcified atherosclerotic plaque burden. Despite the widespread use of novel image reconstruction techniques in CT, the effect of iterative model reconstruction on CAC score remains unclear. We sought to assess the impact of iterative model based reconstruction (IMR) on coronary artery calcium quantification as compared to the standard filtered back projection (FBP) algorithm and hybrid iterative reconstruction (HIR). In addition, we aimed to simulate the impact of iterative reconstruction techniques on calcium scoring based risk stratification of a larger asymptomatic population. We studied 63 individuals who underwent CAC scoring. Images were reconstructed with FBP, HIR and IMR and CAC scores were measured. We estimated the cardiovascular risk reclassification rate of IMR versus HIR and FBP in a larger asymptomatic population (n = 504). The median CAC scores were 147.7 (IQR 9.6-582.9), 107.0 (IQR 5.9-526.6) and 115.1 (IQR 9.3-508.3) for FBP, HIR and IMR, respectively. The HIR and IMR resulted in lower CAC scores as compared to FBP (both p < 0.001), however there was no difference between HIR and IMR (p = 0.855). The CAC score decreased by 7.2 % in HIR and 7.3 % in IMR as compared to FBP, resulting in a risk reclassification rate of 2.4 % for both HIR and IMR. The utilization of IMR for CAC scoring reduces the measured calcium quantity. However, the CAC score based risk stratification demonstrated modest reclassification in IMR and HIR versus FBP

Safety and Efficacy of Myval Implantation in Patients with Severe Bicuspid Aortic Valve Stenosis-A Multicenter Real-World Experience.

Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly and is apparent in nearly 50% of candidates for AV replacement. While transcatheter aortic valve implantation (TAVI) is a recommended treatment for patients with symptomatic severe aortic stenosis (AS) at all surgical risk levels, experience with TAVI in severe bicuspid AS is limited. TAVI in BAV is still a challenge due to its association with multiple and complex anatomical considerations. A retrospective study has been conducted to investigate TAVI's procedural and 30-day outcomes using the Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd. Vapi, Gujarat, India) in patients with severe bicuspid AS. Data were collected on 68 patients with severe bicuspid AS who underwent TAVI with the Myval THV. Baseline characteristics, procedural, 30-day echocardiographic and clinical outcomes were collected. The mean age and STS PROM score were 72.6 ± 9.4 and 3.54 ± 2.1. Procedures were performed via the transfemoral route in 98.5%. Major vascular complications (1.5%) and life-threatening bleeding (1.5%) occurred infrequently. No patient had coronary obstruction, second valve implantation or conversion to surgery. On 30-day echocardiography, the mean transvalvular gradient and effective orifice area were 9.8 ± 4.5 mmHg and 1.8 ± 0.4 cm2, respectively. None/trace aortic regurgitation occurred in 76.5%, mild AR in 20.5% and moderate AR in 3%. The permanent pacemaker implantation rate was 8.5% and 30-day all-cause death occurred in 3.0% of cases. TAVI with the Myval THV in selected BAV anatomy is associated with favorable short-term hemodynamic and clinical outcomes

Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement

Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR &gt; 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries

High Risk Retinoblastoma: Prevalence and Success of Treatment in Developing Countries

High Risk Retinoblastoma: Prevalence and Success of Treatment in Developing Countrie

The Use of Levosimendan in Patients Undergoing Left Ventricular Assist Device Implantation to Mitigate the Risk of Early Postoperative Right Heart Failure (Euro LEVO-LVAD Study): An Analysis of the EUROMACS Registry

Purpose Right heart failure (RHF) has been reported in 20% to 50% of patients receiving an LVAD. However, optimal management strategies are not well described. In the EUROMACS RHF score study, early severe RHF was reported in 22% of patients on LVAD. Patients who developed RHF had significantly increased mortality. Furthermore, patients who develop severe RHF have a 4-fold increase in the length of ICU stay. In contrast to conventional inotropes, levosimendan (LEVO) is a first-in-class inotropic agent that acts as a calcium sensitizer. It increases cardiac output and stroke volume and reduces peripheral vascular resistance without increasing myocardial oxygen consumption, and therefore without an increased risk of serious arrhythmia or myocardial “exhaustion”. Furthermore, it has a long therapeutic effect that may last for weeks, due to the long half-life of one of its active metabolites. In a recent two meta-analyses, LEVO use was associated with improvement of a wide range hemodynamic and clinical outcomes in patients undergoing ECMO support or in patients with ambulatory end-stage heart failure. The aim of our study was to evaluate the effect of levosimendan on early postoperative RHF, major adverse effects, and mortality in patients undergoing LVAD implantation Methods The EUROMACS registry was used to identify adult patients with contemporary continuous-flow LVAD implantations. The index cohort (n=393) comprises patients on LVAD who received perioperative LEVO. The control cohort will be identified from the registry (n=3856) via propensity score matching. Matched patients with and without perioperative use of LEVO will be compared for baseline, procedural characteristics as well as co-medication. Differences between groups will be assessed by the student's t-test, Chi-squared test, and Kruskal-Wallis tests when appropriate. Kaplan-Meier curves will be reconstructed for 30-day and 1-year survival between the two cohorts Endpoints The primary endpoint is the rate of early (30 days) postoperative RHF between LEVO and no LEVO cohort. Secondary endpoints are 30-day and 1-year survival. Other secondary endpoints include ICU and hospital length of stay, major or life-threatening bleeding, stroke, AKI, thromboembolism, sepsis, and multiorgan failur