Journal of cardiovascular computed tomography最新文献

Background: Murray-law based quantitative flow ratio, namely μFR, was recently validated to compute fractional flow reserve (FFR) from coronary angiographic images in the cath lab. Recently, the μFR algorithm was applied to coronary computed tomography angiography (CCTA) and a semi-automated computed μFR (CT-μFR) showed good accuracy in identifying flow-limiting coronary lesions prior to referral of patients to the cath lab. We aimed to evaluate the diagnostic accuracy of an artificial intelligence-powered method for fully automatic CCTA reconstruction and CT-μFR computation, using cath lab physiology as reference standard.

Methods: This was a post-hoc blinded analysis of the prospective CAREER trial (NCT04665817). Patients who underwent CCTA, coronary angiography including FFR within 30 days were included. Cath lab physiology standard for determining hemodynamically significant coronary stenosis was defined as FFR≤0.80, or μFR≤0.80 when FFR was not available.

Results: Automatic CCTA reconstruction and CT-μFR computation was successfully achieved in 657 vessels from 242 patients. CT-μFR showed good correlation (r ​= ​0.62, p ​< ​0.001) and agreement (mean difference ​= ​-0.01 ​± ​0.10, p ​< ​0.001) with cath lab physiology standard. Patient-level diagnostic accuracy for CT-μFR to identify patients with hemodynamically significant stenosis was 83.0 ​% (95%CI: 78.3%-87.8 ​%), with sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio of 84.2 ​%, 81.9 ​%, 82.1 ​%, 84.0 ​%, 4.7 and 0.2, respectively. Average analysis time for CT-μFR was 1.60 ​± ​0.34 ​min per patient.

Conclusion: The fully automatic CT-μFR yielded high feasibility and good diagnostic performance in identifying patients with hemodynamically significant stenosis prior to referral of patients to the cath lab.

Purpose: To characterize preprocedural coronary atherosclerotic lesions derived from CCTA and assess their association with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).

Materials and methods: This retrospective cohort-study included patients who underwent CCTA for suspected coronary artery disease, subsequent index angiography including PCI and surveillance angiography within 6-8 months after the index procedure. We performed a plaque analysis of culprit lesions on CCTA using a dedicated plaque analysis software including assessment of the surrounding pericoronary fat attenuation index (FAI) and compared findings between lesions with and without ISR at surveillance angiography after stenting.

Results: Overall 278 coronary lesions in 209 patients were included. Of these lesions, 43 (15.5 ​%) had ISR at surveillance angiography after stenting while 235 (84.5 ​%) did not. Likewise, plaque composition such as volume of calcification [129.8 mm³ (83.3-212.6) vs. 94.4 mm³ (60.4-160.5) p ​= ​0.06] and lipid-rich and fibrous plaque volume [38.4 mm³ (19.4-71.2) vs. 38.0 mm³ (14.0-59.1), p ​= ​0.11 and 50.4 mm³ (26.1-77.6) vs. 42.1 mm³ (31.1-60.3), p ​= ​0.16] between lesion with and without ISR were not statistically significant. However lesions associated with ISR were more eccentric (n ​= ​37, 86.0 ​% versus n ​= ​159, 67,7 ​%; p ​= ​0.03) and more frequently demonstrated calcified portions on opposite sides on the vessel wall on cross-sectional datasets (n ​= ​24, 55.8 ​% versus n ​= ​55, 23.4 ​%, p ​= ​0.001). FAI_lesion was significantly different in lesions with ISR as compared to those without ISR [-76.5 (-80.1 to -73.6) vs. -80.9 (-88.9 to -74.0), p ​= ​0.02]. There was no difference with respect to FAI_RCA between the two groups [-77.4 (-81.9 to -75.6) vs. -78.5 (-86.0 to -71.0), p ​= ​0.41].

Conclusion: Coronary lesions associated with ISR at surveillance angiography demonstrated differences in the arrangement of calcified portions as well as an increased lesion-specific pericoronary fat attenuation index at baseline CCTA. This latter finding suggests that perivascular inflammation at baseline may play a major role in the development of in-stent restenosis.

Background: Disparities exist in medicine and can affect patient care. We sought to understand influences of racial biases in diagnostic testing within a Cardiac CT (CCT) population.

Methods: Race of CCT patients, referring physicians and the population in the catchment area were captured between February 2006 and November 2021. The frequency of CCT referrals for each race was indexed to the catchment population.

Results: Of 21,241 CCT patients, 17,514 (82.5 ​%) patients were White. The Non-White population was comprised of 467(2.2 ​%) Indigenous, 656(3.1 ​%) Black, 932(4.4 ​%) Asian, 276(1.3 ​%) South Asian, 1100(5.2 ​%) Middle Eastern and 296(1.4 ​%) Latin American races. The catchment population was 907,675, with 619,514 individuals of whom 69.7 ​% identified as White. Compared to the catchment population, there was a disproportionately higher referral rate for Whites than Non-Whites. The referral index for Whites was higher than Non-Whites (1.2 versus 0.6, p ​< ​0.001)). This pattern was consistent across all racial minorities and age categories. A total of 356 physicians (236(66.3 ​%) White, 4(1.2 ​%) Black, 39(12.0 ​%) Asian, 30(9.2 ​%) South Asian, 43(13.2 ​%), Middle Eastern and 4 (1.2 ​%) Latin American) made referrals to CCT. The racial difference in referral patterns was independent of physician race and was independent of their years in practice.

Conclusions: Racial differences exist in CCT referrals. These differences are independent of prevalence of disease, physician race or years in practice. This study supports the need to better understand reasons for disparity and strategies to mitigate potential bias.

Background: Prospective ECG-triggered cardiac computed tomography (CT) imaging limits the ability to assess left ventricular (LV) ejection fraction (EF). We previously developed a new index derived from LV volume changes over 100 ​ms during systole (LVEF_100msec) as a surrogate of LV function in patients undergoing prospective ECG-triggered cardiac CT. We sought to evaluate the prognostic value of LVEF_100msec.

Methods: Patients undergoing prospective systolic ECG-triggered cardiac CT were enrolled between January 2015 and September 2022. Each CT was analyzed for LVEF_100msec. Area under the curve analysis and Cox proportional hazards models were used to define the best LVEF_100msec cut-off and to predict major adverse cardiovascular events (MACE), defined as a composite of all-cause death, cardiac death/arrest, non-fatal myocardial infarction, and stroke.

Results: The study enrolled 313 patients (median age ​= ​58 years, male ​= ​52.4 ​%). During a median follow-up of 924 (660-1365) days, 24 (7.7 ​%) patients had MACE. LVEF_100msec was significantly lower in the MACE group compared to the non-MACE group (4.8 ​% vs. 8.3 ​%, p ​= ​0.002). Optimal LVEF_100msec cut-off for predicting MACE was 6.3 ​%. MACE-free survival rate was significantly lower in patients with LVEF_100msec ≤6.3 ​% than those with >6.3 ​% (p ​< ​0.001). LVEF_100msec ≤6.3 ​% was an independent predictor of MACE, with an adjusted hazard ratio of 3.758 (95 ​% CI, 1.543-9.148; p ​= ​0.004). The prognostic value of LVEF_100msec was consistent across the various severities of coronary artery disease.

Conclusion: LVEF_100msec was an independent predictor of adverse events. The implementation of LVEF_100msec may improve the prognostic value of prospective ECG-triggered cardiac CT.

Background: We aimed to compare computed tomography (CT)-derived myocardial strain between patients with constrictive pericarditis (CP) and a matched healthy control group and to identify factors associated with clinical outcomes after pericardiectomy.

Methods: This retrospective study included 65 patients with CP (mean age: 58.9 ​± ​8.0 years) and 65 healthy individuals (mean age: 58.0 ​± ​6.5 years) who underwent multiphase cardiac CT. The type of CP was classified as calcified CP or fibrotic CP. CT-derived strains from four cardiac chambers were compared between the CP and control groups, as well as between different types of CP. Clinical and CT-derived factors associated with adverse outcomes were identified using Cox regression analysis.

Results: Compared with the control group, the CP group showed significantly lower values of left atrium (LA) reservoir strain (15.7 ​% vs. 27.4 ​%), right atrium (RA) reservoir strain (15.1 ​% vs. 27.0 ​%), left ventricle (LV) global longitudinal strain (GLS) (-17.0 ​% vs. -19.5 ​%), and right ventricle free wall longitudinal strain (-21.1 ​% vs. -25.9 ​%) (all p ​< ​0.001). Biatrial reservoir strains and LV GLS were significantly lower in those with calcified CP compared to those with fibrotic CP. LA reservoir strain (hazard ratio, 0.91-95 ​% confidence interval, 0.86-0.96- p ​= ​0.001) was an independent prognostic factor for adverse events in patients with CP.

Conclusion: Cardiac strain differences in CP were predominantly observed in the LA and RA compared to the healthy control group. Biatrial reservoir strains were specifically impaired in those with calcified CP than in those with fibrotic CP. LA reservoir strain was associated with prognosis in patients with CP following pericardiectomy.

Coronary CT angiography (CCTA) and fractional flow reserve with CCTA (FFRCT) have been endorsed by the ACC/AHA Chest Pain guidelines to streamline the diagnosis of coronary artery disease (CAD), but there is still a significant lack of adherence. In our study of 673 stable chest patients without known CAD from 5 European countries, we found that CCTA is the most common noninvasive diagnostic test, but nearly 40 ​% of them still underwent upfront CAD. Additionally, there was no temporal improvement trend, and the integration of FFRCT is low. We highlighted the urgent need to improve diagnostic processes and update reimbursement policies.

Background: Discrepancies between stenosis severity assessed at coronary computed tomography angiography (CCTA) and ischemia might depend on vessel type. Coronary plaque features are associated with ischemia. Thus, we evaluated the vessel-specific correlation of CCTA-derived diameter stenosis (DS) and invasive fractional flow reserve (FFR) and explored whether integrating morphological plaque features stratified by vessel might increase the predictive yield in identifying vessel-specific ischemia.

Methods: Observational cohort study including patients undergoing CCTA for suspected coronary artery disease, with at least one vessel with DS ​≥ ​50 ​% at CCTA, undergoing invasive coronary angiography and FFR. Plaque analysis was performed using validated semi-automated software. Coronary vessels were stratified in left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). Per vessel independent predictors of ischemia among CCTA-derived anatomical and morphologic plaque features were tested at univariable and multivariable logistic regression analysis. The best cut-off to predict ischemia was determined by Youden's index. Ischemia was defined by FFR≤0.80.

Results: The study population consisted of 192 patients, of whom 224 vessels (61 ​% LAD, 19 ​% LCX, 20 ​% RCA) had lesions with DS ​≥ ​50 ​% interrogated by FFR. Despite similar DS, the rate of FFR≤0.80 was higher in the LAD compared to LCX and RCA (67.2 ​% vs 43.2 ​% and 44.2 ​%, respectively, p ​= ​0.018). A significant correlation between DS and FFR was observed only in LAD (p ​= ​0.003). At multivariable analysis stratified by vessel, the vessel-specific independent predictors of positive FFR were percent atheroma volume (threshold>17 ​%) for LAD, non-calcified plaque volume (threshold >130 ​mm³) for LCX, and lumen volume (threshold <844 ​mm³) for RCA. Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for ischemia compared to DS alone (AUC ranging from 0.51 to 0.63 to 0.76-0.80).

Conclusions: Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for vessel-specific ischemia compared to DS alone, potentially improving patients' referral to the catheterization laboratory.

Cardiac imagers, radiologists or cardiologists, do not receive adequate training or preparation for the harsh realities of running imaging programs and most of the training follows graduation where they are learning on the job and from their own mistakes. There are many factors and skill sets need to help imagers to run a successful and financially independent practice that are easily not easily acquired or researched independently. The intent of this review is to provide a checklist of steps recommended to create a successful program and to give insight into the financial considerations associated with workforce, equipment, training and sustainability. The challenges faced are broadly similar between practice types, but some distinct differences do exist within varying practice environments.

Background: Quantifying myocardial extracellular volume (ECV) using computed tomography (CT) has been shown to be useful in the evaluation of cardiac amyloidosis. However, the reproducibility of CT measurements for myocardial ECV, is not well-established in patients with proven cardiac amyloidosis.

Methods: This prospective single-center study enrolled cardiac amyloidosis patients to undergo dual-energy CT for myocardial fibrosis assessment. Delayed imaging at 7 and 8 ​min post-contrast and independent evaluations by two blinded cardiologists were performed for ECV quantification using 16-segment (ECV_global) and septal sampling (ECV_septal). Inter- and intraobserver variability and test-retest reliability were measured using Spearman's rank correlation, Bland-Altman analysis, and intraclass correlation coefficients (ICC).

Results: Among the 24 participants (median age ​= ​78, 67 ​% male), CT ECV_global and ECV_septal showed median values of 53.6 ​% and 49.1 ​% at 7 ​min, and 53.3 ​% and 50.1 ​% at 8 ​min, respectively. Inter- and intraobserver variability and test-retest reliability for CT ECV_global (ICC ​= ​0.798, 0.912, and 0.894, respectively) and ECV_septal (ICC ​= ​0.791, 0.898, and 0.852, respectively) indicated good reproducibility, with no evidence of systemic bias between observers or scans.

Conclusions: Dual-energy CT-derived ECV measurements demonstrated good reproducibility in patients with proven cardiac amyloidosis, suggesting potential utility as a repeatable imaging biomarker for this disease.