Assessment of myocardial and LV blood pool post-contrast T1 evolution: comparison between healthy subjects and patients with hypertrophic cardiomyopathy

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CoreValve vs. Sapien 3 transcatheter aortic valve replacement: a finite element analysis study

Aim: to investigate the factors implied in the development of postoperative complications in both self-expandable and balloon-expandable transcatheter heart valves by means of finite element analysis (FEA). Materials and methods: FEA was integrated into CT scans to investigate two cases of postoperative device failure for valve thrombosis after the successful implantation of a CoreValve and a Sapien 3 valve. Data were then compared with two patients who had undergone uncomplicated transcatheter heart valve replacement (TAVR) with the same types of valves. Results: Computational biomechanical modeling showed calcifications persisting after device expansion, not visible on the CT scan. These calcifications determined geometrical distortion and elliptical deformation of the valve predisposing to hemodynamic disturbances and potential thrombosis. Increased regional stress was also identified in correspondence to the areas of distortion with the associated paravalvular leak. Conclusion: the use of FEA as an adjunct to preoperative imaging might assist patient selection and procedure planning as well as help in the detection and prevention of TAVR complications

Prognostic value of CMR-derived extracellular volume in AL amyloidosis: a multicenter study

Background: This study aimed to assess the prognostic value of cardiac magnetic resonance (CMR) variables and compare them with biological and echocardiographic markers in patients with AL cardiac amyloidosis (CA). Methods: We conducted a prospective study across three tertiary centres, where patients underwent clinical examination, blood tests, echocardiography, and CMR. The primary endpoint was all-cause mortality. Results: A total of 176 patients with AL CA were included, with a median age of 68 years (IQR 58-75). According to the 2004 Mayo Clinic staging, 121 patients (69%) were in stage 3. During a median follow-up of 22 months (IQR 8-48), 45 patients died, and 55 were hospitalized for heart failure. Patients who died had higher NT-proBNP and troponin levels, and lower LVEF, cardiac output, and longitudinal strain. Among CMR variables, extracellular volume (ECV) was most strongly associated with all-cause mortality. In multivariate Cox models, including Mayo Clinic staging, ECV ≥ 0.45 was independently associated with mortality (HR 2.36, CI 95% 1.47-5.60) and also with heart failure hospitalizations (HR 4.10, 95%CI 2.15-8.8). Conclusion: ECV is a powerful predictor of outcomes in AL CA, providing additional prognostic value on top of Mayo Clinic staging

0013: Feasibility, image quality and radiation dose of Coronary CT Angiography (CCTA) in patients with atrial fibrillation using a new generation 256 Multi-Detector CT (MDCT)

IntroductionTo evaluate feasibility, image quality and radiation dose of CCTA in patients with atrial fibrillation (AF) using a new generation 256-MDCT.Methods and materialsThirty consecutive patients (mean HR 103.8±52.2 bpm) with AF underwent CCTA on a 256-MDCT (Revolution CT, General Electric). Prevalence and impact on diagnosis of motion and step artifacts were independently evaluated by two experienced readers using a 3-point scale (0: no artifact; 1: artifacts without interference on diagnosis; 2: artifacts interfere with diagnosis) and percentage of assessable coronary segments was calculated. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were measured for quantitative assessment. Radiation dose was evaluated by calculating the mean effective dose (ED).ResultsOn a per-patient analysis, all the coronary segments were assessable in 28 (93%) patients. Only 3 coronary segments were not assessable in 2 patients due to motion artefacts resulted in a coronary segments assessability of 99.3% (453/456 segments) in the overall population. No step artifact was observed whereas motion artefacts (3-point scale score of 0.53±0.6) were infrequent and do not interfere with diagnosis. The mean CNR and mean SNR were respectively 13.3±4.6 and 13.0±3.3. ED remains low with an average of 3.3±2.5 mSv.ConclusionCCTA is feasible in AF patients using a new generation 256-MDCT providing good image quality and low radiation dose in this challenging population

0012: Comparison of Coronary CT Angiography (CCTA) for patients with high heart rates using a new generation 256 Multi-Detector CT (MDCT) and a 64-MDCT: image quality and radiation dose

PurposeTo evaluate the benefits regarding image quality and radiation dose of new generation 256 Multi-Detector CT (MDCT) for CCTA in patients with a high heart rate (HR).MethodsHundred consecutive patients with a HR>65bpm were retrospectively included (50 patients on a 64-MDCT, group A, 73.9±7.5 bpm; 50 patients on a 256-MDCT, group B, 85.8±30.0bpm). Prevalence and impact on diagnosis of motion and step artifacts were evaluated by two experienced readers using a 3-point scale (0: no artifact; 1: artifacts without interference on diagnosis; 2: artifacts interfere with diagnosis) and percentage of assessable coronary segments was calculated. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were measured for quantitative assessment. Radiation dose was evaluated by calculating the mean effective dose (ED).ResultsIn group B, motion artefacts were significantly reduced (0.58±0.64 vs 1.37±0.72, p<0.001) and no step artifact was observed (vs. 0.98±0.79, p<0.001). That resulted in a significant improvement in coronary segments assessability in group B (98.6% vs 80.9%, p<0.001). Both mean CNR and mean SNR were increased by 20% (p<0.001) in group B and ED was reduced by 82% (14.9±4.9 vs. 2.7±1.9 mSv p<0.001).ConclusionNew generation 256-MDCT allows performing pure arterial CCTA on high heart rate patients with improved image quality and coronary segments assessability, and reduced radiation dose