Multimodality cardiovascular imaging in pulmonary embolism

Acute pulmonary embolism (APE) is one of the leading causes of cardiovascular (CV) morbidity andmortality. To select appropriate therapeutic strategy and/or to minimize the mortality and morbidity,rapid and correct identification of life-threatening APE is very important. Also, right ventricular (RV)failure usually precedes acute hemodynamic compromise or death, and thus the identification of RVfailure is another important step in risk stratification or treatment of APE. With advances in diagnosisand treatment, the prognosis of APE has been dramatically improving in most cases, but inadequatetherapy or recurrent episodes of pulmonary embolism (PE) may result in negative outcomes or, so called,chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a condition characterized byremaining chronic thromboembolic material in the pulmonary vasculature and subsequent chronicpulmonary hypertension.Various imaging modalities include chest computed tomography pulmonary angiography (CTPA),echocardiography, magnetic resonance imaging, and nuclear imaging and each are used for the assessmentof varying status of PE. Assessment of thromboembolic burden by chest CTPA is the first step inthe diagnosis of PE. Hemodynamic assessment can be achieved by echocardiography and also by chestCTPA. Nuclear imaging is useful in discriminating CTEPH from APE.Better perspectives on diagnosis, risk stratification and decision making in PE can be provided bycombining multimodality CV imaging. Here, the advantages or pitfalls of each imaging modality indiagnosis, risk stratification, or management of PE will be discussed

Comparative analysis of heart functions in micropigs and conventional pigs using echocardiography and radiography

The production of miniature animals has been suggested for use in organ transplantation. At present, many of the studies about application of animal organs to human have been focused on pigs because of the number of advantages involved and due to their similarities with human. However, a physiological analysis of the organs to be transplanted has not yet been carried out. Therefore, this study analyzed whether or not there were physiological and morphological differences in the hearts of conventionally-reared pigs and micropigs. In this study, the morphological and physiological functions of the heart were examined using radiographic and echocardiographic equipment. In the lateral radiographic view, the heart of the micropig has a larger cardiac long axis : short axis ratio than does the conventional pig, but the difference in the vertebral heart score was not significant. In addition, there were no morphological differences on the X-ray fluoroscopic view. There were no differences in echocardiographic values, except for several values in the left ventricle traces. Overall, it is expected that the values measured in this study will contribute to understanding of the physiological characteristics of micropigs

Unusual Cause of Acute Right Ventricular Dysfunction: Rapid Progression of Superior Vena Cava Aneurysm Complicated by Thrombosis and Pulmonary Thromboembolism

Aneurysms of the major thoracic veins are rare. They are usually asymptomatic and thus treated conservatively. We report an extremely rare case of rapidly progressing superior vena cava (SVC) aneurysm complicated by thrombosis and acute pulmonary thromboembolism (PTE) with right ventricular dysfunction. Thrombolytic therapy for hemodynamically significant acute PTE was harmful to the patient in the present case, because it induced further thrombosis and mobilization of the thrombi within the aneurysm, subsequently causing de novo PTE. Surgical aneurysmectomy combined with pulmonary artery embolectomy would be a treatment of choice in patients with SVC aneurysm complicated by acute PTE

Comparison of two automated CT perfusion software packages in patients with ischemic stroke presenting within 24 h of onset

BackgroundWe compared the ischemic core and hypoperfused tissue volumes estimated by RAPID and JLK-CTP, a newly developed automated computed tomography perfusion (CTP) analysis package. We also assessed agreement between ischemic core volumes by two software packages against early follow-up infarct volumes on diffusion-weighted images (DWI).MethodsThis retrospective study analyzed 327 patients admitted to a single stroke center in Korea from January 2021 to May 2023, who underwent CTP scans within 24 h of onset. The concordance correlation coefficient (ρ) and Bland–Altman plots were utilized to compare the volumes of ischemic core and hypoperfused tissue volumes between the software packages. Agreement with early (within 3 h from CTP) follow-up infarct volumes on diffusion-weighted imaging (n = 217) was also evaluated.ResultsThe mean age was 70.7 ± 13.0 and 137 (41.9%) were female. Ischemic core volumes by JLK-CTP and RAPID at the threshold of relative cerebral blood flow (rCBF) < 30% showed excellent agreement (ρ = 0.958 [95% CI, 0.949 to 0.966]). Excellent agreement was also observed for time to a maximum of the residue function (Tmax) > 6 s between JLK-CTP and RAPID (ρ = 0.835 [95% CI, 0.806 to 0.863]). Although early follow-up infarct volume showed substantial agreement in both packages (JLK-CTP, ρ = 0.751 and RAPID, ρ = 0.632), ischemic core volumes at the threshold of rCBF <30% tended to overestimate ischemic core volumes.ConclusionJLK-CTP and RAPID demonstrated remarkable concordance in estimating the volumes of the ischemic core and hypoperfused area based on CTP within 24 h from onset