Comparison of rhythm versus rate control of atrial fibrillation in heart failure subgroups: Systematic review and meta-analysis of randomized controlled trials.

Patients with concurrent heart failure (HF) and atrial fibrillation (AF) have poor outcomes. Randomized clinical trials comparing rhythm control approaches to rate control of AF have yielded conflicting results and there is a paucity of updated and comprehensive evidence summaries to inform best practice in HF patients. We therefore conducted a systematic review and meta-analysis to compare outcomes with rhythm versus rate control of AF in various subgroups of HF patients.

Mineralocorticoid Receptor Antagonism Prevents Aortic Plaque Progression and Reduces Left Ventricular Mass and Fibrosis in Patients With Type 2 Diabetes and Chronic Kidney Disease: The MAGMA Trial.

Background: Persistent mineralocorticoid receptor activation is a pathologic response in type 2 diabetes and chronic kidney disease. Whereas mineralocorticoid receptor antagonists are beneficial in reducing cardiovascular complications, direct mechanistic pathways for these effects in humans are lacking.

Methods: The MAGMA trial (Mineralocorticoid Receptor Antagonism Clinical Evaluation in Atherosclerosis) was a randomized, double-blind, placebo-controlled trial in patients with high-risk type 2 diabetes with chronic kidney disease (not receiving dialysis) on maximum tolerated renin-angiotensin system blockade.

Clinical impact of right ventricular pacing burden in patients with post-transcatheter aortic valve replacement permanent pacemaker implantation.

Aims: Patients who undergo permanent pacemaker (PPM) implantation after transcatheter aortic valve replacement (TAVR) have a worse outcome. The aim of this study was to identify risk factors of worse outcomes in patients with post-TAVR PPM implantation.

Methods And Results: This is a single-centre, retrospective study of consecutive patients who underwent post-TAVR PPM implantation from 11 March 2011 to 9 November 2019.

A New WATCHMAN Sizing Algorithm Utilizing Cardiac CTA.

Background: The WATCHMAN left atrial appendage (LAA) occlusion device has emerged as an alternative for anticoagulation in patients with non-valvular atrial fibrillation who cannot tolerate oral anticoagulation therapy. Cardiac computed tomography (CTA) is increasingly being utilized to guide WATCHMAN device sizing, however no consensus algorithm exists. We present our experience with a new cardiac CTA LAA ostium area based sizing algorithm.

Seizure symptoms and ambulatory EEG findings: incidence of epileptiform discharges.

Aims: Ambulatory video-EEG monitoring has been utilized as a cost-effective alternative to inpatient video-EEG monitoring for non-surgical diagnostic evaluation of symptoms suggestive of epileptic seizures. We aimed to assess incidence of epileptiform discharges in ambulatory video-EEG recordings according to seizure symptom history obtained during clinical evaluation.

Methods: This was a retrospective cohort study.

Transcatheter Valve Implantation for Failed Surgical Aortic and Mitral Bioprostheses: A Single-Center Experience.

Objectives: We share our center's experience with the use of transcatheter valvular therapies in the setting of failed bioprostheses.

Background: As medicine continues to advance, the lifespan of individuals continues to increase, and current surgical valvular therapies begin to degrade prior to a person's end of life. It is important to evaluate the efficacy and durability of transcatheter valves within failed surgical bioprostheses.

An assessment of the quality of optical coherence tomography image acquisition.

Optical coherence tomography (OCT) provides excellent image resolution, however OCT optimal acquisition is essential but could be challenging owing to several factors. We sought to assess the quality of OCT pullbacks and identify the causes of suboptimal image acquisition. We evaluated 784 (404 pre-PCI; 380 post-PCI) coronary pullbacks from an anonymized OCT database from our Cardiovascular Imaging Core Laboratory.

SLICR super-voxel algorithm for fast, robust quantification of myocardial blood flow by dynamic computed tomography myocardial perfusion imaging.

We created and evaluated a processing method for dynamic computed tomography myocardial perfusion imaging (CT-MPI) of myocardial blood flow (MBF), which combines a modified simple linear iterative clustering algorithm (SLIC) with robust perfusion quantification, hence the name SLICR. SLICR adaptively segments the myocardium into nonuniform super-voxels with similar perfusion time attenuation curves (TACs). Within each super-voxel, an α-trimmed-median TAC was computed to robustly represent the super-voxel and a robust physiological model (RPM) was implemented to semi-analytically estimate MBF.

Real World Utilization of Computed Tomography Derived Fractional Flow Reserve: Single Center Experience in the United States.

Background: Fractional flow reserve derived from computed tomography (FFRct) has shown higher accuracy for detection of significant coronary artery disease (CAD) compared to coronary computed tomography angiography (CCTA). The performance of a combined comprehensive qualitative interpretation of both CCTA and FFRct in patient management is unknown. We aimed to explore the clinical application of this combined approach.

Calibration-free beam hardening correction for myocardial perfusion imaging using CT.

Purpose: Computed tomography myocardial perfusion imaging (CT-MPI) and coronary CTA have the potential to make CT an ideal noninvasive imaging gatekeeper exam for invasive coronary angiography. However, beam hardening (BH) artifacts prevent accurate blood flow calculation in CT-MPI. BH correction methods require either energy-sensitive CT, not widely available, or typically, a calibration-based method in conventional CT.

The role of acquisition and quantification methods in myocardial blood flow estimability for myocardial perfusion imaging CT.

In this work, we clarified the role of acquisition parameters and quantification methods in myocardial blood flow (MBF) estimability for myocardial perfusion imaging using CT (MPI-CT). We used a physiologic model with a CT simulator to generate time-attenuation curves across a range of imaging conditions, i.e.

Rupture of a Non-Obstructive Plaque.

An invasive and non-invasive imaging series representing a classic rupture of a non-obstructive plaque with thin-cap fibroatheroma.

Left Atrium Wall-mapping Application for Wall Thickness Visualisation.

The measurement method for the LA wall thickness (WT) using cardiac computed tomography (CT) is observer dependent and cannot provide a rapid and comprehensive visualisation of the global LA WT. We aim to develop a LA wall-mapping application to display the global LA WT on a coplanar plane. The accuracy, intra-observer, and inter-observer reproducibility of the application were validated using digital/physical phantoms, and CT images of eight patients.

SLIC robust (SLICR) processing for fast, robust CT myocardial blood flow quantification.

There are several computational methods for estimating myocardial blood flow (MBF) using CT myocardial perfusion imaging (CT-MPI). Previous work has shown that model-based deconvolution methods are more accurate and precise than model-independent methods such as singular value decomposition and max-upslope. However, iterative optimization is computationally expensive and models are sensitive to image noise, thus limiting the utility of low x-ray dose acquisitions.

In-hospital outcomes of transcatheter versus surgical aortic valve replacement in end stage renal disease.

Background: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (AS) who are at intermediate and high risk for surgery. Commercial use of TAVR has expanded to patients with end stage renal disease (ESRD).

Objectives: Compare in-hospital outcomes of TAVR versus SAVR in ESRD patients requiring hemodialysis (HD).

New insight to estimate under-expansion after stent implantation on bifurcation lesions using optical coherence tomography.

Optical coherence tomography (OCT) allows full volumetric segmentation of the lumen. However, for the estimation of stent under-expansion we still rely on the conventional method (CM) of single cross-sectional narrowing compared with reference vessel, likely masking true lesion significance, especially for bifurcations and tapered vessels. We, therefore, suggest a novel concept of volumetric metrics that take into account vessel tapering and major side branches and is capable of obtaining ideal lumen area for every frame of the stent by OCT.

Design of the Magnetic Resonance Imaging Evaluation of Mineralocorticoid Receptor Antagonism in Diabetic Atherosclerosis (MAGMA) Trial.

Mineralocorticoid receptor (MR) activation plays an essential role in promoting inflammation, fibrosis, and target organ damage. Currently, no studies are investigating MR antagonism in patients with type 2 diabetes mellitus (T2DM) with chronic kidney disease, at high risk for cardiovascular complications, who are otherwise not candidates for MR antagonism by virtue of heart failure. Further, there is limited information on candidate therapies that may demonstrate differential benefit from this therapy.

Improvements in Left Ventricular Diastolic Mechanics After Parachute Device Implantation in Patients With Ischemia Heart Failure: A Cardiac Computerized Tomographic Study.

Background: Percutaneous ventricular restoration therapy with the use of a left ventricle (LV)-partitioning Parachute device has emerged as a clinical treatment option for LV apical aneurysm after extensive anterior myocardial infarction (AMI). We assessed changes of diastolic mechanics and functional improvements following LV Parachute device implantation by means of cardiac computerized tomography (CCT).

Methods And Results: CCT data were obtained from 28 patients before and after LV Parachute device implantation.

Failure Mechanisms and Neoatherosclerosis Patterns in Very Late Drug-Eluting and Bare-Metal Stent Thrombosis.

Background: There are few clinical studies on the pathophysiological mechanisms of very late stent thrombosis (VLST). We report optical coherence tomography findings in patients with VLST and compare the findings between bare-metal stents (BMS) and drug-eluting stents (DES).

Methods And Results: We conducted a registry of stent thrombosis at 4 North American centers with optical coherence tomography imaging programs SAFE registry (The Study of Late Stent Failure Evaluated by OCT).

Evaluating the quality of implantation of percutaneous ventricular restoration device (Parachute®) by cardiac computed tomography.

Background: The Parachute is a novel percutaneously implanted ventricular partitioning device (VPD) that has emerged as a safe and feasible treatment option for patients with heart failure following anterior wall myocardial infarction. VPD efficacy is likely dependent on optimal device placement, but to date there are no published data examining the effect of device positioning on patient outcomes.

Methods And Results: We retrospectively identified 32 patients successfully implanted with the Parachute device, all of whom underwent cardiac computed tomography (CCT) at baseline and after 6 months of follow-up.

Impact of Neointimal Calcifications on Acute Stent Performance during the Treatment of In-Stent Restenosis.

Optical coherence tomography (OCT) has become the invasive imaging modality of choice for coronary stent assessment due to its unmatched spatial resolution. Neointimal calcification (NC) is a rare finding, observed in 5-10% of in-stent restenosis (ISR) neointima. The impact of NC on percutaneous coronary intervention of ISR is unknown.