Mitral Annular and Coronary Artery Calcification Are Associated with Mortality in HIV-Infected Individuals.

BackgroundHIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals.Methods and resultsWe studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell's C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all).ConclusionIn HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death

Utilization of cardiovascular magnetic resonance (CMR) imaging for resumption of athletic activities following COVID-19 infection: An expert consensus document on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention (CVRI) Leadership and endorsed by the Society for Cardiovascular Magnetic Resonance (SCMR)

The global pandemic of coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory suyndrome coronavirus 2 (SARS-CoV-2) is now entering its 4th year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. While pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play, RTP) following resolution of infection. A variety of different testing combinations that leverage the electrocardiogram, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance (CMR) imaging have been proposed and implemented to mitigate risk. CMR in particular affords high sensitivity for myocarditis but has been employed and interpreted non-uniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to RTP. This consensus document synthesizes available evidence to contextualize the appropriate utilization of CMR in the RTP assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation

Left Atrial Transverse Diameter on Computed Tomography Angiography Can Accurately Diagnose Left Atrial Enlargement in Patients With Atrial Fibrillation

PurposeLeft atrial (LA) enlargement is associated with increased risk for adverse cardiovascular events. We assessed the accuracy of LA transverse and antero-posterior (AP) diameters obtained from chest computed tomography (CT) angiography in patients with atrial fibrillation.Materials and methodsNongated contrast-enhanced 64-slice multidetector CT angiography (slice thickness of 0.625 to 1.25 mm) was used to measure the volume and transverse and AP diameters of the LA in 222 subjects. The internal contours of the LA and LA appendage were outlined in 1 of every 5 axial images, and the LA area was multiplied by 5 times the slice thickness. Maximum transverse and AP diameters of the LA were measured, excluding the appendage. Receiver operating characteristic curves were fitted to assess the accuracy of the diameters. A Wald test was used to compare the area under the curves.ResultsThe mean age of patients was 60.0±10.6 years, and 71% were male. Median LA volume was 55.9±24.4 mL/m. LA enlargement was present in 83% of the patients. Transverse and AP LA diameters were accurate estimators of the LA enlargement. The transverse diameter demonstrated higher accuracy than the AP diameter, with area under the curves of 0.89 (0.84 to 0.94) and 0.81 (0.73 to 0.89), respectively (P<0.05). A transverse LA diameter of 7.3 cm had a sensitivity and specificity of 85% for detection of LA enlargement. At the same sensitivity level, an AP diameter of 4.3 cm had a specificity of 60.5%.ConclusionsTransverse LA diameter can accurately detect LA enlargement in patients with atrial fibrillation. This parameter can be used for detection of patients with possible LA enlargement on chest CT angiography

Society for Cardiovascular Magnetic Resonance (SCMR) guidance for the practice of cardiovascular magnetic resonance during the COVID-19 pandemic

The aim of this document is to provide general guidance and specific recommendations on the practice of cardiovascular magnetic resonance (CMR) in the era of the COVID-19 pandemic. There are two major considerations. First, continued urgent and semi-urgent care for the patients who have no known active COVID-19 should be provided in a safe manner for both patients and staff. Second, when necessary, CMR on patients with confirmed or suspected active COVID-19 should focus on the specific clinical question with an emphasis on myocardial function and tissue characterization while optimizing patient and staff safety

Machine learning in cardiovascular radiology:ESCR position statement on design requirements, quality assessment, current applications, opportunities, and challenges

Machine learning offers great opportunities to streamline and improve clinical care from the perspective of cardiac imagers, patients, and the industry and is a very active scientific research field. In light of these advances, the European Society of Cardiovascular Radiology (ESCR), a non-profit medical society dedicated to advancing cardiovascular radiology, has assembled a position statement regarding the use of machine learning (ML) in cardiovascular imaging. The purpose of this statement is to provide guidance on requirements for successful development and implementation of ML applications in cardiovascular imaging. In particular, recommendations on how to adequately design ML studies and how to report and interpret their results are provided. Finally, we identify opportunities and challenges ahead. While the focus of this position statement is ML development in cardiovascular imaging, most considerations are relevant to ML in radiology in general. KEY POINTS: • Development and clinical implementation of machine learning in cardiovascular imaging is a multidisciplinary pursuit. • Based on existing study quality standard frameworks such as SPIRIT and STARD, we propose a list of quality criteria for ML studies in radiology. • The cardiovascular imaging research community should strive for the compilation of multicenter datasets for the development, evaluation, and benchmarking of ML algorithms

Society for Cardiovascular Magnetic Resonance (SCMR) guidance for re-activation of cardiovascular magnetic resonance practice after peak phase of the COVID-19 pandemic

During the peak phase of the COVID-19 pandemic, alterations of standard operating procedures were necessary for health systems to protect patients and healthcare workers and ensure access to vital hospital resources. As the peak phase passes, re-activation plans are required to safely manage increasing clinical volumes. In the context of cardiovascular magnetic resonance (CMR), re-activation objectives include continued performance of urgent CMR studies and resumption of CMR in patients with semi-urgent and elective indications in an environment that is safe for both patients and health care workers

Residents Teaching Medical Students: How Do They Compare With Attending Educators?

PurposeEducating medical students is a core mission of academic radiology departments. In some programs, residents participate in student teaching. The aim of this study was to retrospectively compare medical student evaluations of radiology resident lectures with lecture evaluations of radiology faculty members.MethodsNumeric evaluations for lectures given by faculty members, fellows, and residents were collected over a 1-year period as part of routine course evaluations for a fourth-year medical student radiology elective. Faculty member, fellow, and resident lecture scores were compared, overall using analysis of variance and pairwise using Student's t test. A predefined low P-value threshold was used for the t tests to account for the multiple comparisons. To account for the inherent clustering of the data due to repeat lecturers, the data were reanalyzed on a "per lecturer" basis.ResultsThree hundred seven individual lecture scores were collected. There was no statistical difference between the lecture scores received by attending faculty members (mean, 9.10 on a scale of 10) and residents (mean, 8.99) (P = .08). Fellows, however, scored statistically significantly lower (mean, 8.45) than attending faculty members and residents (P <.001 for both comparisons). The per lecturer analysis yielded similar results.ConclusionsLectures delivered by residents received similar evaluations as lectures delivered by faculty members. Given that teaching can be an educational experience for residents, involving radiology residents in medical student teaching may benefit students and residents alike

Human Embryonic and Rat Adult Stem Cells with Primitive Endoderm-Like Phenotype Can Be Fated to Definitive Endoderm, and Finally Hepatocyte-Like Cells

Stem cell-derived hepatocytes may be an alternative cell source to treat liver diseases or to be used for pharmacological purposes. We developed a protocol that mimics mammalian liver development, to differentiate cells with pluripotent characteristics to hepatocyte-like cells. The protocol supports the stepwise differentiation of human embryonic stem cells (ESC) to cells with characteristics of primitive streak (PS)/mesendoderm (ME)/definitive endoderm (DE), hepatoblasts, and finally cells with phenotypic and functional characteristics of hepatocytes. Remarkably, the same protocol can also differentiate rat multipotent adult progenitor cells (rMAPCs) to hepatocyte-like cells, even though rMAPC are isolated clonally from cultured rat bone marrow (BM) and have characteristics of primitive endoderm cells. A fraction of rMAPCs can be fated to cells expressing genes consistent with a PS/ME/DE phenotype, preceding the acquisition of phenotypic and functional characteristics of hepatocytes. Although the hepatocyte-like progeny derived from both cell types is mixed, between 10–20% of cells are developmentally consistent with late fetal hepatocytes that have attained synthetic, storage and detoxifying functions near those of adult hepatocytes. This differentiation protocol will be useful for generating hepatocyte-like cells from rodent and human stem cells, and to gain insight into the early stages of liver development