P. Egea-Serrano, A. Vidal-Garcia, S. Montalban-Larrea, A. Pelaez, A. Castilla
Background: Myocardial ischemia may be caused by microvascular disease. The ratio of the maximal possible coronary blood flow to the resting coronary blood flow is termed “the coronary flow reserve” (CFR), which may be assessed noninvasively via dipyridamole stress echocardiography (DSE). Ranolazine is an anti-ischemic agent whose effect on the coronary flow is poorly known. Purpose: We sought to assess temporal variations in the CFR after and before ranolazine administration in a real clinical practice setting among patients with angina and non-obstructive epicardial coronary artery disease. Methods: Seven patients were enrolled, and their demographic, electrocardiographic, and laboratory data were recorded. The CFR was calculated in the anterior descending coronary artery. The definition of abnormal microcirculation was a cutoff value under 2.5. Treatment lasted for 3 months, after which time the same response variables as before were recorded. A general linear model was used to assess whether there was a difference between the preand post-administration of ranolazine. Results: Seven patients were evaluated. At follow-up, there was no discontinuation or side effect. The CFR significantly increased with time (F1,6 = 6.909; P = 0.039). Initially, the mean (± 1 SD) value was 1.85 (±0.34), which rose up to 2.21 (±0.31) after the 3-month treatment period. Conclusions: Ranolazine might have beneficial effects on the CFR as assessed by DSE in patients with angina and non-obstructive epicardial coronary artery disease.
{"title":"Noninvasive Assessment of Coronary Flow Reserve Before and After Ranolazine Administration: Does It Improve in Our Real Patients?","authors":"P. Egea-Serrano, A. Vidal-Garcia, S. Montalban-Larrea, A. Pelaez, A. Castilla","doi":"10.5812/ACVI.58285","DOIUrl":"https://doi.org/10.5812/ACVI.58285","url":null,"abstract":"Background: Myocardial ischemia may be caused by microvascular disease. The ratio of the maximal possible coronary blood flow to the resting coronary blood flow is termed “the coronary flow reserve” (CFR), which may be assessed noninvasively via dipyridamole stress echocardiography (DSE). Ranolazine is an anti-ischemic agent whose effect on the coronary flow is poorly known. Purpose: We sought to assess temporal variations in the CFR after and before ranolazine administration in a real clinical practice setting among patients with angina and non-obstructive epicardial coronary artery disease. Methods: Seven patients were enrolled, and their demographic, electrocardiographic, and laboratory data were recorded. The CFR was calculated in the anterior descending coronary artery. The definition of abnormal microcirculation was a cutoff value under 2.5. Treatment lasted for 3 months, after which time the same response variables as before were recorded. A general linear model was used to assess whether there was a difference between the preand post-administration of ranolazine. Results: Seven patients were evaluated. At follow-up, there was no discontinuation or side effect. The CFR significantly increased with time (F1,6 = 6.909; P = 0.039). Initially, the mean (± 1 SD) value was 1.85 (±0.34), which rose up to 2.21 (±0.31) after the 3-month treatment period. Conclusions: Ranolazine might have beneficial effects on the CFR as assessed by DSE in patients with angina and non-obstructive epicardial coronary artery disease.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134364262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Postpartum Takotsubo cardiomyopathy is mainly induced by drugs that enhance sympathetic nervous activity. We report a novel case of postpartum inverted Takotsubo cardiomyopathy triggered by intravenous atropine administration resulting in acute pul-monaryedema. CardiactroponinIandbeta-typenatriureticpeptidewereelevated. TransthoraciccolorDopplerechocardiography demonstrated a nondilated left ventricle with mid-basal akinesis, a hyperdynamic apex, and moderate-to-severe mitral regurgitation likely linked to papillary muscle dysfunction. Coronary computed tomography angiography revealed normal coronary ar-teries. Atropine inhibits the parasympathetic nervous system, alters the autonomic system balance, and, thus, leads to increased sympatheticnervousactivity,whichseemstohavebeenthecauseof Takotsubocardiomyopathyinthispatient. Atropineshouldbe listed among the drugs triggering Takotsubo cardiomyopathy. Cardiomyopathy, Cardiomyopathies, Echocardiography Doppler Color, Atropine
{"title":"Postpartum Inverted Takotsubo Cardiomyopathy After Intravenous Atropine Administration","authors":"R. Diaz-Navarro, P. Nihoyannopoulos","doi":"10.5812/ACVI.46095","DOIUrl":"https://doi.org/10.5812/ACVI.46095","url":null,"abstract":"Postpartum Takotsubo cardiomyopathy is mainly induced by drugs that enhance sympathetic nervous activity. We report a novel case of postpartum inverted Takotsubo cardiomyopathy triggered by intravenous atropine administration resulting in acute pul-monaryedema. CardiactroponinIandbeta-typenatriureticpeptidewereelevated. TransthoraciccolorDopplerechocardiography demonstrated a nondilated left ventricle with mid-basal akinesis, a hyperdynamic apex, and moderate-to-severe mitral regurgitation likely linked to papillary muscle dysfunction. Coronary computed tomography angiography revealed normal coronary ar-teries. Atropine inhibits the parasympathetic nervous system, alters the autonomic system balance, and, thus, leads to increased sympatheticnervousactivity,whichseemstohavebeenthecauseof Takotsubocardiomyopathyinthispatient. Atropineshouldbe listed among the drugs triggering Takotsubo cardiomyopathy. Cardiomyopathy, Cardiomyopathies, Echocardiography Doppler Color, Atropine","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120941661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A variant of takotsubo cardiomyopathy is the inverted takotsubo type, where the wall motion abnormalities affect the basal and mid segments but spare the apex. We describe a case of this variant induced by cocaine and methamphetamine consumption. There are reported cases of transient apical ballooning associated with drug abuse, but none of them presented with the inverted variant and low cardiac output treated with levosimendan.
{"title":"Heart Failure in a Case of Inverted Takotsubo Cardiomyopathy due to Cocaine and Methamphetamine Abuse Treated with Levosimendan","authors":"I. K. Yañez, S. Nicolás-Franco, J. A. Olivas","doi":"10.5812/ACVI.14401","DOIUrl":"https://doi.org/10.5812/ACVI.14401","url":null,"abstract":"A variant of takotsubo cardiomyopathy is the inverted takotsubo type, where the wall motion abnormalities affect the basal and mid segments but spare the apex. We describe a case of this variant induced by cocaine and methamphetamine consumption. There are reported cases of transient apical ballooning associated with drug abuse, but none of them presented with the inverted variant and low cardiac output treated with levosimendan.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116018378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Wejner-Mik, P. Lipiec, E. Szymczyk, J. Kasprzak
Introduction: Leftventricular(LV)freewallruptureisararebutcatastrophiccomplicationof acuteST-elevationmyocardialinfarc-tion (STEMI) and is still present in the era of aggressive reperfusion therapy. CasePresentation: An81-year-oldmanwithahistoryof hypertensionanddyslipidemiawasadmittedtoourhospitalwithanterior STEMI. While being prepared for coronary angiography, the patient underwent a focused 2D and Doppler echocardiographic study, which revealed akinesis in the apical segments of the LV and hyperkinesis in the adjacent segments, with a mild impairment in the LVejectionfraction(46%). Thispatternof regionalwallmotionabnormalitieswasconfirmedbyspeckle-trackingechocardiography. Fifteen minutes after hospital admission, he suffered sudden cardiac arrest, for which resuscitation was commenced immediately. Repeatechocardiographyrevealedmassivepericardialeffusion,resultingincardiactamponade. Pericardiocentesiswasperformed, but the ensuing resuscitation efforts were unsuccessful. Conclusions: Wepresentauniquerecordingandquantitativeanalysisof theLVwallmotionabnormalitiesimmediatelypreceding freewallruptureinnonrevascularizedanteriorSTEMI.Wehypothesizethatsignificantdifferencesintheregionalfunction,ranging from an akinetic apex to hypercontractile segments adjacent to the necrotic zone, can represent a marker of threatened cardiac rupture.
{"title":"Strain Echocardiography Immediately Before Acute Left Ventricular Rupture Following Anterior Wall Myocardial Infarction","authors":"P. Wejner-Mik, P. Lipiec, E. Szymczyk, J. Kasprzak","doi":"10.5812/ACVI.61448","DOIUrl":"https://doi.org/10.5812/ACVI.61448","url":null,"abstract":"Introduction: Leftventricular(LV)freewallruptureisararebutcatastrophiccomplicationof acuteST-elevationmyocardialinfarc-tion (STEMI) and is still present in the era of aggressive reperfusion therapy. CasePresentation: An81-year-oldmanwithahistoryof hypertensionanddyslipidemiawasadmittedtoourhospitalwithanterior STEMI. While being prepared for coronary angiography, the patient underwent a focused 2D and Doppler echocardiographic study, which revealed akinesis in the apical segments of the LV and hyperkinesis in the adjacent segments, with a mild impairment in the LVejectionfraction(46%). Thispatternof regionalwallmotionabnormalitieswasconfirmedbyspeckle-trackingechocardiography. Fifteen minutes after hospital admission, he suffered sudden cardiac arrest, for which resuscitation was commenced immediately. Repeatechocardiographyrevealedmassivepericardialeffusion,resultingincardiactamponade. Pericardiocentesiswasperformed, but the ensuing resuscitation efforts were unsuccessful. Conclusions: Wepresentauniquerecordingandquantitativeanalysisof theLVwallmotionabnormalitiesimmediatelypreceding freewallruptureinnonrevascularizedanteriorSTEMI.Wehypothesizethatsignificantdifferencesintheregionalfunction,ranging from an akinetic apex to hypercontractile segments adjacent to the necrotic zone, can represent a marker of threatened cardiac rupture.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"899 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132347946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Measurement of the left ventricular ejection fraction (LVEF) is a common tool for evaluating the left ventricle (LV) systolic function. The aim of this study was to evaluate and compare the LVEF and mitral regurgitation (MR) severity as estimated by angiography and echocardiography in patients with coronary artery disease (CAD) and LV systolic dysfunction. Methods: In this observational study, 39 men and 11 women at a mean age of 60 years were recruited. The patients underwent catheterization and echocardiography, and the data on the LVEF and MR by both methods were registered. Results: The mean LVEF by echocardiography and angiography was significantly correlated (correlation coefficient = 0.698; P < 0.0001). Although there was agreement between these methods in the estimation of the mean EF (mean difference in the LVEF = 1.23 ± 7.63% and 95% limit of agreement = −12.5–19) and the κ coefficient was 45.7% (P = 0.001), the estimated mean EF was 32.6 ± 10.25% by echocardiography and 29.8 ± 8.2% by angiography (P = 0.007). Furthermore, there was a statistically significant difference in the estimated MR severity between the two methods (P = 0.0001), with echocardiography reporting higher degrees of severity than angiography. Conclusions: In our patients with CAD and LV systolic dysfunction, after the exclusion of age, sex, number of diseased coronary arteries, and myocardial infarction history from the analysis, although the mean LVEF by echocardiography and angiography was significantly correlated, echocardiography estimated higher LVEF values than angiography, especially in the patients with triple-vessel disease. Moreover, echocardiography showed higher degrees of MR severity than angiography.
{"title":"Left ventricular ejection fraction and mitral regurgitation assessment: A comparison study between echocardiography and angiography","authors":"A. Mirdamadi, Negah Tavakolifard, Ehsan Ebrahimi","doi":"10.4103/ACVI.ACVI_7_18","DOIUrl":"https://doi.org/10.4103/ACVI.ACVI_7_18","url":null,"abstract":"Introduction: Measurement of the left ventricular ejection fraction (LVEF) is a common tool for evaluating the left ventricle (LV) systolic function. The aim of this study was to evaluate and compare the LVEF and mitral regurgitation (MR) severity as estimated by angiography and echocardiography in patients with coronary artery disease (CAD) and LV systolic dysfunction. Methods: In this observational study, 39 men and 11 women at a mean age of 60 years were recruited. The patients underwent catheterization and echocardiography, and the data on the LVEF and MR by both methods were registered. Results: The mean LVEF by echocardiography and angiography was significantly correlated (correlation coefficient = 0.698; P < 0.0001). Although there was agreement between these methods in the estimation of the mean EF (mean difference in the LVEF = 1.23 ± 7.63% and 95% limit of agreement = −12.5–19) and the κ coefficient was 45.7% (P = 0.001), the estimated mean EF was 32.6 ± 10.25% by echocardiography and 29.8 ± 8.2% by angiography (P = 0.007). Furthermore, there was a statistically significant difference in the estimated MR severity between the two methods (P = 0.0001), with echocardiography reporting higher degrees of severity than angiography. Conclusions: In our patients with CAD and LV systolic dysfunction, after the exclusion of age, sex, number of diseased coronary arteries, and myocardial infarction history from the analysis, although the mean LVEF by echocardiography and angiography was significantly correlated, echocardiography estimated higher LVEF values than angiography, especially in the patients with triple-vessel disease. Moreover, echocardiography showed higher degrees of MR severity than angiography.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126442589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ventricular diverticula are a rare congenital abnormality characterized by synchronized contractility. Isolated diverticula mostly remain asymptomatic until adulthood. In this case report, we describe a 22-year-old woman with a history of pain in her arms and cold-induced skin discoloration. She was evaluated with echocardiography and cardiac magnetic resonance imaging, which illustrated a muscular basal diverticulum in the left ventricle.
{"title":"Isolated congenital left ventricular diverticula: A rare cardiac anomaly","authors":"N. Rezaeian, H. Najafi","doi":"10.4103/ACVI.ACVI_12_18","DOIUrl":"https://doi.org/10.4103/ACVI.ACVI_12_18","url":null,"abstract":"Ventricular diverticula are a rare congenital abnormality characterized by synchronized contractility. Isolated diverticula mostly remain asymptomatic until adulthood. In this case report, we describe a 22-year-old woman with a history of pain in her arms and cold-induced skin discoloration. She was evaluated with echocardiography and cardiac magnetic resonance imaging, which illustrated a muscular basal diverticulum in the left ventricle.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122602620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Farveh Vakilan, F. Ghaderi, H. Poorzand, M. Shabestari, Arash Gholobi
Arteriovenous fistula could be traumatic with one manifestation as high-output heart failure. We present a 29-year-old male, referred for unexplained right-sided enlargement and the symptoms of right ventricular failure for 8 months ago. Considering right-sided dilatation, marked inferior vena cava plethora, and increased pulmonary passage of flow in the absence of intracardiac shunts, arteriovenous shunt was suspected. He had a history of penetrating abdominal trauma which raised the suspicion for further evaluation. Abdominal sonography and contrast-enhanced computed tomography revealed a large arteriovenous fistula between the left common iliac artery and vein. The patient underwent successful percutaneous repair with a stent graft and dramatic improvement in symptoms and resolution of flushing and edema.
{"title":"Arteriovenous fistula presented with right ventricular failure","authors":"Farveh Vakilan, F. Ghaderi, H. Poorzand, M. Shabestari, Arash Gholobi","doi":"10.4103/ACVI.ACVI_2_19","DOIUrl":"https://doi.org/10.4103/ACVI.ACVI_2_19","url":null,"abstract":"Arteriovenous fistula could be traumatic with one manifestation as high-output heart failure. We present a 29-year-old male, referred for unexplained right-sided enlargement and the symptoms of right ventricular failure for 8 months ago. Considering right-sided dilatation, marked inferior vena cava plethora, and increased pulmonary passage of flow in the absence of intracardiac shunts, arteriovenous shunt was suspected. He had a history of penetrating abdominal trauma which raised the suspicion for further evaluation. Abdominal sonography and contrast-enhanced computed tomography revealed a large arteriovenous fistula between the left common iliac artery and vein. The patient underwent successful percutaneous repair with a stent graft and dramatic improvement in symptoms and resolution of flushing and edema.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134636729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Azin Alizadeasl, F. Noohi, F. Larti, S. Hosseini, M. Maleki
Tumors that involve the heart are more likely to represent metastatic disease than do primary cardiac neoplasms. Cardiac metastases from a renal cell carcinoma are rare and would be unique when there is no contiguous vena caval involvement such as the case that will be described here.
{"title":"Cardiac metastasis from a renal cell carcinoma without contiguous vena caval involvement","authors":"Azin Alizadeasl, F. Noohi, F. Larti, S. Hosseini, M. Maleki","doi":"10.4103/ACVI.ACVI_8_18","DOIUrl":"https://doi.org/10.4103/ACVI.ACVI_8_18","url":null,"abstract":"Tumors that involve the heart are more likely to represent metastatic disease than do primary cardiac neoplasms. Cardiac metastases from a renal cell carcinoma are rare and would be unique when there is no contiguous vena caval involvement such as the case that will be described here.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126930600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"3D Analysis of Thin-Cap Fibroatheromas by an Automatic Graph-Based Approach in Intravascular Optical Coherence Tomography","authors":"A. Kermani, A. Taki, A. Ayatollahi","doi":"10.5812/ACVI.45187","DOIUrl":"https://doi.org/10.5812/ACVI.45187","url":null,"abstract":"","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116669049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hamidreza Pooraliakbar, Maryam Khalili Sadrabad, Z. Emkanjoo, M. Haghjoo, Ahmadali Khalili Sadrabad
Background: Trying to reduce radiation exposure from cardiac imaging is mandatory while maintaining diagnostic image quality (IQ). Using a high-pitch spiral dual-source computed tomography (DSCT) protocol for left atrial (LA) mapping, we sought to determine IQ and radiation dose in patients with atrial fibrillation scheduled for radiofrequency ablation. Methods: Fifty-nine patients (29 women; mean age = 53 y) underwent CT angiography between 2013 and 2016: 26 patients with retrospective ECG-gated (classic) and 33 with high-pitch (Flash) protocols on a second-generation 128-DSCT system (SOMATOM Definition Flash). CT images of the LA were integrated into an electroanatomic system (NavX). Two independent blinded readers evaluated IQ using a 3-point scale and the LA contrast density. Dose-length product (DLP) was obtained from each patient protocol, and effective radiation dose (ERD) was calculated according to the European guideline for CT. Results: The rate of diagnostic IQ (score 3 or 2) was 87.9% for the flash group and 96.2% for the classic group, which was not significantly different between the 2 groups (P = 0.250). The results of objective IQ measurements showed that a central LA contrast density above 350 Hounsfield units (diagnostic) was present in 21 (80.8%) images in the classic group and 26 (78.8%) images in the flash group, which was not statistically different between the 2 groups (P = 0.850). There were significant differences (P < 0.001) in DLP and ERD between the 2 groups: the values were lower in high-pitch scan than in retrospective ECG-gated scan (151.30± 39.44 vs. 776.61 ± 243.63 and 2.11 ± 0.55 vs. 10.872 ± 3.41, respectively). Conclusions: High-pitch (Flash) DSCT is an acceptable CT angiography method for reducing radiation dose without compromising IQ for LA and pulmonary venous imaging in patients with atrial fibrillation.
{"title":"Left Atrial Mapping in Patients with Atrial Fibrillation: A Comparison Study of Image Quality and Radiation Dose Between High-Pitch Spiral CT Angiography and Retrospective ECG-Gated CT Angiography","authors":"Hamidreza Pooraliakbar, Maryam Khalili Sadrabad, Z. Emkanjoo, M. Haghjoo, Ahmadali Khalili Sadrabad","doi":"10.5812/ACVI.13307","DOIUrl":"https://doi.org/10.5812/ACVI.13307","url":null,"abstract":"Background: Trying to reduce radiation exposure from cardiac imaging is mandatory while maintaining diagnostic image quality (IQ). Using a high-pitch spiral dual-source computed tomography (DSCT) protocol for left atrial (LA) mapping, we sought to determine IQ and radiation dose in patients with atrial fibrillation scheduled for radiofrequency ablation. Methods: Fifty-nine patients (29 women; mean age = 53 y) underwent CT angiography between 2013 and 2016: 26 patients with retrospective ECG-gated (classic) and 33 with high-pitch (Flash) protocols on a second-generation 128-DSCT system (SOMATOM Definition Flash). CT images of the LA were integrated into an electroanatomic system (NavX). Two independent blinded readers evaluated IQ using a 3-point scale and the LA contrast density. Dose-length product (DLP) was obtained from each patient protocol, and effective radiation dose (ERD) was calculated according to the European guideline for CT. Results: The rate of diagnostic IQ (score 3 or 2) was 87.9% for the flash group and 96.2% for the classic group, which was not significantly different between the 2 groups (P = 0.250). The results of objective IQ measurements showed that a central LA contrast density above 350 Hounsfield units (diagnostic) was present in 21 (80.8%) images in the classic group and 26 (78.8%) images in the flash group, which was not statistically different between the 2 groups (P = 0.850). There were significant differences (P < 0.001) in DLP and ERD between the 2 groups: the values were lower in high-pitch scan than in retrospective ECG-gated scan (151.30± 39.44 vs. 776.61 ± 243.63 and 2.11 ± 0.55 vs. 10.872 ± 3.41, respectively). Conclusions: High-pitch (Flash) DSCT is an acceptable CT angiography method for reducing radiation dose without compromising IQ for LA and pulmonary venous imaging in patients with atrial fibrillation.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"86 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126092166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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