Subclinical leaflet thrombosis is associated with impaired reverse remodelling after transcatheter aortic valve implantation

Cardiac CT is increasingly applied for planning and follow-up of transcatheter aortic valve implantation (TAVI). However, there are no data available on reverse remodelling after TAVI assessed by CT. Therefore, we aimed to evaluate the predictors and the prognostic value of left ventricular (LV) reverse remodelling following TAVI using CT angiography.We investigated 117 patients with severe, symptomatic aortic stenosis (AS) who underwent CT scanning before and after TAVI procedure with a mean follow-up time of 2.6 years after TAVI. We found a significant reduction in LV mass (LVM) and LVM indexed to body surface area comparing pre- vs. post-TAVI images: 180.5 ± 53.0 vs. 137.1 ± 44.8 g and 99.7 ± 25.4 vs. 75.4 ± 19.9 g/m2, respectively, both P < 0.001. Subclinical leaflet thrombosis (SLT) was detected in 25.6% (30/117) patients. More than 20% reduction in LVM was defined as reverse remodelling and was detected in 62.4% (73/117) of the patients. SLT, change in mean pressure gradient on echocardiography and prior myocardial infarction was independently associated with LV reverse remodelling after adjusting for age, gender, and traditional risk factors (hypertension, body mass index, diabetes mellitus, and hyperlipidaemia): OR = 0.27, P = 0.022 for SLT and OR = 0.22, P = 0.006 for prior myocardial infarction, OR = 1.51, P = 0.004 for 10 mmHg change in mean pressure gradient. Reverse remodelling was independently associated with favourable outcomes (HR = 0.23; P = 0.019).TAVI resulted in a significant LVM regression on CT. The presence of SLT showed an inverse association with LV reverse remodelling and thus it may hinder the beneficial LV structural changes. Reverse remodelling was associated with improved long-term prognosis

Korszerű koronáriaintervenció CT-vezérléssel: terápiás tervezés és előnyök

A koszorúér-CT-angiográfi a (CCTA) hatékony és megbízható noninvazív modalitás az obstruktív koszorúér-betegség (CAD) kizárására, stabil mellkasi panaszokkal bíró betegek körében. Az elmúlt években tapasztalt dinamikus technológiai fejlődésnek köszönhetően, a térbeli és időbeli felbontás javulásával a CCTA diagnosztikus teljesítményének további javulása várható, így biztosítva a hatékony kapuőrfunkciót az invazív kivizsgálást megelőzően. Továbbá a CAD kiterjedtségének, súlyosságának és lokalizációjának meghatározása révén a betegek rizikóstratifi kációja és szekunder prevenciós kezelése optimalizálható. Továbbá obstruktív szűkület esetén a CCTA által nyújtott morfológiai információk (a léziók lokalizációja, hossza, összetétele) segíthetik az optimális stent kiválasztását, valamint teljes okklúzió esetén pontosabban megítélhető az intervenció sikeressége is. A koronáriarendszer anatómiai jellemzésén felül CT segítségével funkcionális információ is nyerhető (CT-FFR vagy perfúziós CT-vizsgálat), valamint új posztprocesszing szoftverek fejlesztésével az invazív beavatkozást követő várható FFR-érték is becsülhető, amely kiemelt segítséget nyújthat komplex perkután koronáriaintervenciók (PCI) tervezéséhez. Jelen összefoglaló közleményben a CCTA technikai újításait és a PCI-tervezésben betöltött szerepét foglaljuk össze

Coronary CTA Amidst the COVID-19 Pandemic: A Quicker Examination Protocol with Preserved Image Quality Using a Dedicated Cardiac Scanner

There has been an ongoing debate on the means to minimize the time patients spend at health care providers during the COVID-19 pandemic. We propose a strategy relying solely on intravenous (i.v.) beta-blocker administration for heart-rate (HR) control prior to coronary CT angiography (CCTA). We aimed to assess a potential difference in CCTA image quality (IQ) after implementation of a modified strategy compared to our standard protocol of oral premedication during the first wave of COVID-19. We analyzed CCTA examinations conducted one year before (n = 1511) and after (n = 1064) implementation of this new regime. Examinations were performed both on our 256-slice multidetector CT (MDCT) and dedicated cardiac CT (DCCT) scanners. We used a four-point Likert scale (excellent/good/moderate/non-diagnostic) for IQ assessment of the coronaries. We detected a significant increase in mean HR during examinations on both CT scanners (MDCT: 62.4 ± 10.0 vs. 65.3 ± 9.7, p p p p = 0.38). The improved temporal resolution of DCCT allows the stand-alone use of i.v. premedication with preserved IQ; hence, the duration of visits can be shortened

The Impact of Novel Reconstruction Algorithms on Calcium Scoring: Results on a Dedicated Cardiac CT Scanner

Contemporary reconstruction algorithms yield the potential of reducing radiation exposure by denoising coronary computed tomography angiography (CCTA) datasets. We aimed to assess the reliability of coronary artery calcium score (CACS) measurements with an advanced adaptive statistical iterative reconstruction (ASIR-CV) and model-based adaptive filter (MBAF2) designed for a dedicated cardiac CT scanner by comparing them to the gold-standard filtered back projection (FBP) calculations. We analyzed non-contrast coronary CT images of 404 consecutive patients undergoing clinically indicated CCTA. CACS and total calcium volume were quantified and compared on three reconstructions (FBP, ASIR-CV, and MBAF2+ASIR-CV). Patients were classified into risk categories based on CACS and the rate of reclassification was assessed. Patients were categorized into the following groups based on FBP reconstructions: 172 zero CACS, 38 minimal (1–10), 87 mild (11–100), 57 moderate (101–400), and 50 severe (4003, 4.0 (0.0–103.5) mm3 using ASIR-CV, and 5.0 (0.0–118.5) mm3 with MBAF2+ASIR-CV (all comparisons p < 0.001). The concomitant use of ASIR-CV and MBAF2 may allow the reduction of noise levels while maintaining similar CACS values as FBP measurements

Heart Rate-Dependent Degree of Motion Artifacts in Coronary CT Angiography Acquired by a Novel Purpose-Built Cardiac CT Scanner

Although reaching target heart rate (HR) before coronary CT angiography (CCTA) is still of importance, adequate HR control remains a challenge for many patients. Purpose-built cardiac scanners may provide optimal image quality at higher HRs by further improving temporal resolution. We aimed to compare the amount of motion artifacts on CCTA acquired using a dedicated cardiac CT (DCCT) compared to a conventional multidetector CT (MDCT) scanner. We compared 80 DCCT images to 80 MDCT scans matched by sex, age, HR, and coronary dominance. Image quality was graded on a per-patient, per-vessel and per-segment basis. Motion artifacts were assessed using Likert scores (1: non-diagnostic, 2: severe artifacts, 3: mild artifacts, 4: no artifacts). Patients were stratified into four groups according to HR (&lt;60/min, 60&ndash;65/min, 66&ndash;70/min and &gt;70/min). Overall, 2328 coronary segments were evaluated. DCCT demonstrated superior overall image quality compared to MDCT (3.7 &plusmn; 0.4 vs. 3.3 &plusmn; 0.7, p &lt; 0.001). DCCT images yielded higher Likert scores in all HR ranges, which was statistically significant in the 60&ndash;65/min, 66&ndash;70/min and &gt;70/min ranges (3.9 &plusmn; 0.2 vs. 3.7 &plusmn; 0.2, p = 0.008; 3.5 &plusmn; 0.5 vs. 3.1 &plusmn; 0.6, p = 0.048 and 3.5 &plusmn; 0.4 vs. 2.7 &plusmn; 0.7, p &lt; 0.001, respectively). Using a dedicated cardiac scanner results in fewer motion artifacts, which may allow optimal image quality even in cases of high HRs