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

Left ventricular filling patterns in patients with previous myocardial infarction measured by conventional cine cardiac magnetic resonance

To explore left ventricular filling patterns in patients with a history of previous myocardial infarction (MI) using time-volume curves obtained from conventional cine-cardiac magnetic resonance (CMR) examinations. Consecutive patients with a history of previous MI who were referred for CMR evaluation constituted the study population, and a consecutive cohort of sex and age-matched patients with a normal CMR constituted the control group. The following CMR diastolic parameters were evaluated: peak filling rate (PFR), time to PFR (tPFR), normalised PFR adjusted for diastolic volume at PFR (nPFR), and percent RR interval between end systole and PFR. Fifty patients were included, 25 with a history of previous MI and 25 control. The mean age was 59.6 ± 13.9 years and 27 (54%) were male. Within the control group, age was significantly related to PFR (r = -0.53, p = 0.007), whereas among patients with previous MI age was not related to PFR (r = -0.16, p = 0.44). PFR (252.4 ± 96.7 ml/s vs. 316.0 ± 126.4 ml/s, p = 0.05) and nPFR (1.6 ± 1.2 vs. 3.3 ± 1.5, p<0.001) were significantly lower in patients with previous MI, whereas no significant differences were detected regarding tPFR (143.0 ± 67.5 ms vs. 176.2 ± 83.9 ms, p = 0.13) and % RR to PFR (18.1 ± 9.7% vs. 20.6 ± 12.2%, p = 0.44). MI size was related to LV ejection fraction (r = -0.76, p<0.001), PFR (r = -0.40, p = 0.004), nPFR (r = -0.52, p<0.001) and left atrium area (r = 0.40, p = 0.004). Patients at the lowest PFR quartile (<200 ml/s) showed a larger MI size (Q1 26.5 ± 25.5%, Q2 15.5 ± 20.9%, Q3 6.3 ± 12.4%, Q4 8.8 ± 14.1%, p = 0.04). At multivariate analysis, MI size was the only independent predictor of the lowestPFR (p = 0.017). Infarct size has an impact on LV filling profiles, as assessed by conventional cine CMR without additional specific pulse sequences.Fil: Rodriguez Granillo, Gaston Alfredo. Sanatorio "Otamendi y Miroli S.A.". Servicio de Diagnóstico por Imágenes. Departamento de Imágenes en Cardiología. Centro de Investigaciones Cardiovasculares; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mejía Campillo, Marlon. No especifíca;Fil: Rosales, Miguel A.. Sanatorio "Otamendi y Miroli S.A.". Servicio de Diagnóstico por Imágenes. Departamento de Imágenes en Cardiología. Centro de Investigaciones Cardiovasculares; ArgentinaFil: Bolzán, Gabriel. No especifíca;Fil: Ingino, Carlos. No especifíca;Fil: López, Federico. No especifíca;Fil: Degrossi, Elina. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Lylyk, Pedro. Sanatorio "Otamendi y Miroli S. A."; Argentin

Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions

Background: Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue. Objective: We explored whether regional myocardial hypoenhancement on contrast-enhanced MDCT could be identified with standard coronary artery calcium (CAC) scoring acquisitions with noncontrast CT. Methods: Consecutive patients with a history of MI who were referred for contrast-enhanced MDCT from November 2006 until March 2009 were studied. Noncontrast CT for CAC scoring was also performed. The correlation between regional myocardial hypoenhancement on contrast-enhanced CT and regional myocardial hypoattenuated areas on noncontrast CT was defined. Results: Eighty-three patients (mean age, 61.5 ± 12.5 years; n = 67; 81% male) with previous MI were studied. A total of 1411 myocardial segments were evaluated. Two hundred thirty-nine segments (17%) showed myocardial hypoenhancement by MDCT and 140 segments (9.6%) by CAC. On a patient level, noncontrast CT showed a sensitivity, specificity, positive predictive value, (PPV) and negative predictive value (NPV) of 66% (95% CI, 0.53-0.77), 100% (95% CI, 0.76-1.00), 100% (95% CI, 0.90-1.00), and 41% (95% CI, 0.26-0.58), respectively, to detect myocardial hypoenhancement. On a per segment level, noncontrast CT showed a sensitivity, specificity, PPV, and NPV of 58% (95% CI, 0.51-0.64), 100% (95% CI, 0.99-1.00), 99% (95% CI, 0.94-1.00), and 92% (95% CI, 0.90-0.93), respectively, to detect myocardial hypoenhancement. Conclusions: Our findings suggest that chronic MI can be detected with standard CAC scoring acquisitions. © 2010 Society of Cardiovascular Computed Tomography.Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Rosales, Miguel A.. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Renes, Paola. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Diez, Eduardo. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Pereyra, Jorge. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Gomez, Estela. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: De Lillo, Gustavo. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Degrossi, Elina. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Rodriguez, Alfredo E.. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: McFadden, Eugene P.. Cork University Hospital; Irland

Hyperacute Incidental Late Myocardial Enhancement in Ischemic Stroke Using Chest Spectral CT: Relationship with Etiology

Background: Hyperacute cardiac imaging of patients with acute ischemic stroke (AIS), though desirable, is impractical. Using delayed-enhancement, low-dose, non-gated, chest spectral computed tomography scans (DESCT), we explored the prevalence and patterns of incidental myocardial late iodine enhancement (LIE) and embolic sources, and their relationship with stroke etiology. Methods: Since July 2020, DESCT was performed after cerebrovascular CT angiography (CTA) among patients with suspected AIS undergoing CT using a dual-layer spectral scanner, without additional contrast administration. Images were analyzed using monoenergetic reconstructions and iodine density maps, and the myocardial extracellular volume fraction (ECV, %) was calculated. Results: Eighty patients with AIS were included. DESCT identified a cardiac thrombi in 6 patients (7.5%), and a complex aortic plaque in 4 (5%) cases; reclassifying 5 embolic strokes of uncertain source (28% of ESUS) to cardioembolic (CE, n = 3) and non-CE (n = 2) etiologies. LIE was identified in 38 (48%) patients, most commonly (82%) of ischemic pattern. We did not identify significant relationships between AIS etiology and the presence, pattern, and extent of LIE (p > 0.05); ECV (p = 0.56), severe aortic (p = 0.25) or valvular (p = 0.26) disease, or the extent of coronary calcification (p = 0.39). Patients with evidence of major cardiovascular DESCT findings had higher rates of all-cause death at 90 days (42% vs. 19%, p = 0.037). Conclusions: In this study, hyperacute cardiac imaging of AIS with DESCT identified a high prevalence of incidental cardiac disease predominantly involving LIE of ischemic etiology and mostly not related to the stroke etiology.Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto Alberto C. Taquini de Investigaciones en Medicina Traslacional - Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas "Prof. Dr. Alberto C. Taquini". Instituto Alberto C. Taquini de Investigaciones en Medicina Traslacional; Argentina. Clinica La Sagrada Familia. Instituto Medico ENERI; ArgentinaFil: Cirio, Juan J.. Clinica La Sagrada Familia. Instituto Medico ENERI; ArgentinaFil: Ciardi, Celina. Clinica La Sagrada Familia. Instituto Medico ENERI; ArgentinaFil: Caballero, Maria L.. Clinica La Sagrada Familia. Instituto Medico ENERI; ArgentinaFil: Fontana, Lucia A.. Clinica La Sagrada Familia. Instituto Medico ENERI; ArgentinaFil: Buezas, Mariano D.. Clinica La Sagrada Familia. Instituto Medico ENERI; ArgentinaFil: Diluca, Pablo. Clinica La Sagrada Familia. Instituto Medico ENERI; ArgentinaFil: Lylyk, Pedro. Clinica La Sagrada Familia. Instituto Medico ENERI; Argentin

Sirolimus-Eluting Versus Paclitaxel-Eluting Stent Implantation for the Percutaneous Treatment of Left Main Coronary Artery Disease A Combined RESEARCH and T-SEARCH Long-Term Analysis

ObjectivesThe purpose of this study was to investigate the long-term clinical and angiographic profile of sirolimus-eluting stent (SES) versus paclitaxel-eluting stent (PES) in patients undergoing percutaneous intervention for left main (LM) coronary disease.BackgroundThe long-term clinical and angiographic impact of SES as opposed to PES implantation in this subset of patients is unknown.MethodsFrom April 2002 to March 2004, 110 patients underwent percutaneous intervention for LM stenosis at our institution; 55 patients were treated with SES and 55 with PES. The two groups were well balanced for all baseline characteristics.ResultsAt a median follow-up of 660 days (range 428 to 885), the cumulative incidence of major adverse cardiovascular events was similar (25% in the SES group vs. 29%, in the PES group; hazard ratio 0.88 [95% confidence interval 0.43 to 1.82]; p = 0.74), reflecting similarities in both the composite death/myocardial infarction (16% in the SES group and 18% in the PES group) and target vessel revascularization (9% in the SES group and 11% in the PES group). Angiographic in-stent late loss (mm), evaluated in 73% of the SES group and in 77% of the PES group, was 0.32 ± 74 in the main and 0.36 ± 0.59 in the side branch in the SES group vs. 0.46 ± 0.57 (p = 0.36) and 0.52 ± 0.42 (p = 0.41) in the PES group, respectively.ConclusionsIn consecutive patients undergoing percutaneous LM intervention, PES may perform closely to SES both in terms of angiographic and long-term clinical outcome

Modified scan protocol using multislice CT coronary angiography allows high quality acquisitions in obese patients: a case report

Nearly every cardiovascular functional imaging technique has difficulties in dealing with obese patients and MSCT-CA is not an exception. Excluding such large portion of the coronary population remains a grim limitation of the technique and requires thus a comprehensive re-evaluation. In this report, we show that excellent image quality could be achieved in a morbidly obese patient with the aid of proper management of scan protocols and bolus administration. Providing this complex population an accurate, non-invasive imaging technique represents a major step-forward in cardiovascular imaging.Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Rosales, Miguel A.. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Degrossi, Elina. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Durbano, Inés. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Rodriguez, Alfredo E.. Sanatorio "Otamendi y Miroli S. A."; Argentin

Multislice CT coronary angiography for the detection of burden, morphology and distribution of atherosclerotic plaques in the left main bifurcation

The aim of the study was to explore the differences in plaque burden at different segments of the left main bifurcation and its relationship with the bifurcation angle using high-resolution multislice CT coronary angiography (MSCT). Patients were evaluated using a 40-row MSCT scanner. One observer assessed the localization, severity and distribution of plaques within the left main (LMCA) bifurcation, whereas another observer defined the angle. Fifty patients were included. The mean heart rate was 59.8 ± 7.1. Seventeen (34%) patients presented at least wall irregularities in the LMCA and in the ostial LCx, whereas the ostial LAD was affected in 32 (64%) patients. More than 90% of plaques were located opposite to the flow divider. The median bifurcation angle was 88.5° (IQR 68.8°, 101.4°). Of the 18 patients with a normal ostial LAD, 13 (72%) had a bifurcation angle < 88.5°, whereas the 63% of the patients with any LAD disease had an angle ≥ 88.5° (P = 0.018). In conclusion, at the left main bifurcation, atherosclerotic plaques are commonly located at the ostial LAD and opposite to the flow divider. The angle of the left main bifurcation and the presence of plaques within the bifurcation are closely related.Fil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Rosales, Miguel A.. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Degrossi, Elina. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Durbano, Inés. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Rodriguez, Alfredo E.. Sanatorio "Otamendi y Miroli S. A."; Argentin

Anatomic or functional testing in stable patients with suspected CAD: contemporary role of cardiac CT in the ISCHEMIA trial era

One of the foundations of the management of patients with suspected coronary artery disease (CAD) is to avoid unnecessary invasive coronary angiography (ICA) referrals. However, the diagnostic yield of ICA following abnormal conventional stress testing is low. The ability of ischemia testing to predict subsequent myocardial infarction and death is currently being challenged, and more than half of cardiac events among stable patients with suspected CAD occur in those with normal functional tests. The optimal management of patients with stable CAD remains controversial and ischemia-driven interventions, though improving anginal symptoms, have failed to reduce the risk of hard cardiovascular events. In this context, there is an ongoing debate whether the initial diagnostic test among patients with stable suspected CAD should be a functional test or coronary computed tomography angiography. Aside from considering the specific characteristics of individual patients and local availability and conditions, the choice of the initial test relates to whether the objective concerns its role as gatekeeper for ICA, prognosis, or treatment decision-making. Therefore, the aim of this review is to provide a contemporary overview of these issues and discuss the emerging role of CCTA as the upfront imaging tool for most patients with suspected CAD.Fil: Rodriguez Granillo, Gaston Alfredo. 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; ArgentinaFil: Nieman, Koen. University of Stanford; Estados UnidosFil: Carrascosa, Patricia. Diagnostico Maipu, Buenos Aires; ArgentinaFil: Campisi, Roxana. Diagnostico Maipu, Buenos Aires; ArgentinaFil: Ambrose, John A.. University of California; Estados Unido

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

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