A Structured Literature Review and International Consensus Validation of FORTA Labels of Oral Anticoagulants for Long-Term Treatment of Atrial Fibrillation in Older Patients (OAC-FORTA 2019).

Introduction: Evidence regarding safety and efficacy of oral anticoagulants for the treatment of atrial fibrillation (AFib) in older adults has been assessed regarding the age appropriateness of oral anticoagulants (OAC) according to the FORTA (Fit fOR The Aged) classification (OAC-FORTA). Three years after its first version (OAC-FORTA 2016), an update was initiated to create OAC-FORTA 2019.

Methods: A structured review of randomized controlled clinical trials and summaries of individual product characteristics was performed to detect newly emerged evidence on oral anticoagulants in older patients with AFib.

Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016).

Background: Age appropriateness of anticoagulants for stroke prevention in atrial fibrillation is uncertain.

Objective: To review oral anticoagulants for the treatment of atrial fibrillation in older (age >65 years) people and to classify appropriate and inappropriate drugs based on efficacy, safety and tolerability using the Fit-fOR-The-Aged (FORTA) classification.

Methods: We performed a structured comprehensive review of controlled clinical trials and summaries of individual product characteristics to assess study and total patient numbers, quality of major outcome data and data of geriatric relevance.

Accuracy of prospectively ECG-triggered very low-dose coronary dual-source CT angiography using iterative reconstruction for the detection of coronary artery stenosis: comparison with invasive catheterization.

Objective: To evaluate the image quality and diagnostic accuracy of very low-dose computed tomography (CT) angiography (CTA) for the evaluation of coronary artery stenosis.

Background: Iterative reconstruction (IR) has shown to substantially reduce image noise and hence permit the use of very low-dose data acquisition protocols in coronary CTA.

Methods: Fifty symptomatic patients with an intermediate likelihood for coronary artery disease underwent coronary CTA (heart rate: 59 ± 5 bpm, prospectively ECG-triggered axial acquisition, 100 kV, 160 mAs, 2 × 128 × 0.

Multicenter Evaluation Of Coronary Dual-Source CT angiography in patients with intermediate Risk of Coronary Artery Stenoses (MEDIC): study design and rationale.

Background: The diagnostic performance of multidetector row CT to detect coronary artery stenosis has been evaluated in numerous single-center studies, with only limited data from large cohorts with low-to-intermediate likelihood of coronary disease and in multicenter trials. The Multicenter Evaluation of Coronary Dual-Source CT Angiography in Patients with Intermediate Risk of Coronary Artery Stenoses (MEDIC) trial determines the accuracy of dual-source CT (DSCT) to identify persons with at least 1 coronary artery stenosis among patients with low-to-intermediate pretest likelihood of disease.

Methods: The MEDIC trial was designed as a prospective, multicenter, international trial to evaluate the diagnostic performance of DSCT for the detection of coronary artery stenosis compared with invasive coronary angiography.

Stent evaluation in low-dose coronary CT angiography: effect of different iterative reconstruction settings.

Background: Different iterative reconstruction (IR) techniques compensate increased noise from lower tube current-time product settings, yet the differences between IR settings remain unclear.

Objective: Aim of this study was to test whether different IR settings have a clinically relevant influence on image quality and on the diagnostic accuracy of low-dose CT angiography in patients with a stent.

Methods: Forty-two patients with 73 coronary stents were prospectively enrolled.

Automated attenuation-based selection of tube voltage and tube current for coronary CT angiography: reduction of radiation exposure versus a BMI-based strategy with an expert investigator.

Background: Recently developed automated algorithms use the topogram and the corresponding attenuation information before coronary CT angiography (CTA) to allow for an individualized anatomic-based selection of tube current (mAs) and voltage (kV).

Objectives: The value of these algorithms in reducing the associated radiation exposure was evaluated.

Methods: One hundred patients underwent coronary CTA with dual-source CT with prospectively electrocardiogram-triggered axial data acquisition.

Low-dose dual-source CT angiography with iterative reconstruction for coronary artery stent evaluation.

Objectives: The purpose of this study was to evaluate the image quality and diagnostic accuracy of very low-dose, dual-source computed tomography (DSCT) angiography for the evaluation of coronary stents.

Background: Iterative reconstruction (IR) leads to substantial reduction of image noise and hence permits the use of very low-dose data acquisition protocols in coronary computed tomography angiography.

Methods: Fifty symptomatic patients with 87 coronary stents (diameter 3.

CT predictors of post-procedural aortic regurgitation in patients referred for transcatheter aortic valve implantation: an analysis of 105 patients.

Cardiac computed tomography (CT) allows accurate and detailed analysis of the anatomy of the aortic root and valve, including quantification of calcium. We evaluated the correlation between different CT parameters and the degree of post-procedural aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) using the balloon-expandable Edwards Sapien prosthesis. Pre-intervention contrast-enhanced dual source CT data sets of 105 consecutive patients (48 males, mean age 81 ± 6 years, mean logEuroSCORE 34 ± 13%) with symptomatic severe aortic valve stenosis referred for TAVI using the Edwards Sapien prosthesis (Edwards lifesciences, Inc.

Patient-specific predictors of image noise in coronary CT angiography.

Background: Coronary computed tomography (CT) angiography can be associated with high radiation exposure. Reduction of tube voltage from 120 kV to 100 kV can reduce the dose by up to 40%, but it also increases image noise.

Objective: We aimed to find a patient-specific predictor of image noise to determine the use of reduced tube voltage.

Very low-dose coronary artery calcium scanning with high-pitch spiral acquisition mode: comparison between 120-kV and 100-kV tube voltage protocols.

Background: Effective radiation dose from a single coronary artery calcification CT scan can range from 0.8 to 10.5 mSv, depending on the protocol.

A method to determine suitable fluoroscopic projections for transcatheter aortic valve implantation by computed tomography.

Background: In transcatheter aortic valve implantation (TAVI), optimal selection of fluoroscopic projections that permit orthogonal visualization of the aortic valve plane is important but may be difficult to achieve.

Objective: We developed and validated a simple method to predict suitable fluoroscopic projections on the basis of cardiac CT datasets.

Methods: In 75 consecutive patients that underwent TAVI, angulations in which a 35-mm thick maximum intensity projection would render all aortic valve calcium into 1 plane were determined by manual interaction with contrast-enhanced dual-source CT datasets.

Image quality of ultra-low radiation exposure coronary CT angiography with an effective dose <0.1 mSv using high-pitch spiral acquisition and raw data-based iterative reconstruction.

Objectives: We evaluated the potential of prospectively ECG-triggered high-pitch spiral acquisition with low tube voltage and current in combination with iterative reconstruction to achieve coronary CT angiography with sufficient image quality at an effective dose below 0.1 mSv.

Methods: Contrast-enhanced coronary dual source CT angiography (2 × 128 × 0.

Interobserver agreement for the detection of atherosclerotic plaque in coronary CT angiography: comparison of two low-dose image acquisition protocols with standard retrospectively ECG-gated reconstruction.

Background: We compared the interobserver variability concerning the detection of calcified and non-calcified plaque in two different low-dose and standard retrospectively gated protocols for coronary CTA.

Methods: 150 patients with low heart rates and less than 100 kg body weight were randomised and examined by contrast-enhanced dual-source CT coronary angiography (100 kV, 320 mAs). 50 patients were examined with prospectively ECG-triggered axial acquisition, 50 patients with prospectively ECG-triggered high pitch spiral acquisition, and 50 patients using spiral acquisition with retrospective ECG gating.

Influence of heart rate and phase of the cardiac cycle on the occurrence of motion artifact in dual-source CT angiography of the coronary arteries.

Background: Coronary CT angiography allows visualization of the coronary arteries. However, motion artifact can impair delineation of the coronary artery lumen and detection of coronary artery stenoses.

Objective: We investigated the influence of heart rate and the segment of the cardiac cycle during which images are reconstructed on the occurrence of motion artifacts.

Left ventricular thrombus attenuation characterization in cardiac computed tomography angiography.

Background: Because of their similar visual appearance, differentiation of left ventricular thrombotic material and myocardial wall can be difficult in contrast-enhanced coronary computed tomography (CT) angiography.

Objective: We identified typical thrombi attenuation of left ventricular thrombi with the use of CT measurement.

Methods: Over a time period of 6 years, we retrospectively identified 31 patients who showed a left ventricular thrombus in CT angiography datasets.

Accuracy of dual-source CT to identify significant coronary artery disease in patients with uncontrolled hypertension presenting with chest pain: comparison with coronary angiography.

It has been previously reported that the sensitivity and specificity of multislice CT for detecting significant CAD (coronary artery disease) is high. Chest pain is a common presentation in patients with uncontrolled hypertension. We investigated the sensitivity and specificity of dual-source CT to detect and rule out significant CAD in patients presenting with uncontrolled hypertension accompanied by chest pain.

Which concentration to choose in dual flow cardiac CT?: dual flow cardiac CT.

Purpose: An extensive number of protocols have been suggested to allow for functional diagnostics; however, no data is available about the minimal amount of contrast medium to achieve reliable imaging properties. None of the plethora of existing studies report a rational why the specific concentration was chosen.

Materials And Methods: A total of 40 patients were included in this prospective, controlled study.

Coronary vessel and luminal area measurement using dual-source computed tomography in comparison with intravascular ultrasound: effect of window settings on measurement accuracy.

Background: Image display settings (window and level) have a substantial impact on measurements of coronary artery and plaque dimensions in computed tomography (CT), and their influence on measurement accuracy has not been systematically evaluated. We analyzed the influence of window width/level settings on the accuracy for determining cross-sectional lumen and outer vessel diameters in contrast-enhanced CT angiography compared with intravascular ultrasound (IVUS).

Methods: We evaluated the data sets of 35 patients.

In vivo CT detection of lipid-rich coronary artery atherosclerotic plaques using quantitative histogram analysis: a head to head comparison with IVUS.

Background: Coronary atherosclerotic plaque characterisation may contribute to risk stratification for future cardiovascular events. The ability of computed tomography to classify plaques as 'fibrous' or 'lipid-rich' based on their average CT attenuation has been investigated but is fraught with substantial limitations. In this study, we evaluated the potential of analysing the distribution of CT attenuation values measured in Hounsfield Units (HU) within coronary atherosclerotic plaques to classify non-calcified plaques into fibrous and lipid-rich subtypes.

Right coronary artery fistula to the coronary sinus and right atrium associated with giant right coronary enlargement detected by transthoracic echocardiography.

We present the case of a 54-year-old female with a previous history of lung fibrosis secondary to methotrexate used for rheumatoid arthritis who was referred to cardiology evaluation due to precordial pain. Echocardiography showed biatrial enlargement with an enlarged coronary sinus and tubular image posterior to the heart. On the coronary angiogram, the right coronary artery was enlarged, and a distal fistula was identified.

Iterative reconstruction in image space (IRIS) in cardiac computed tomography: initial experience.

Improvements in image quality in cardiac computed tomography may be achieved through iterative image reconstruction techniques. We evaluated the ability of "Iterative Reconstruction in Image Space" (IRIS) reconstruction to reduce image noise and improve subjective image quality. 55 consecutive patients undergoing coronary CT angiography to rule out coronary artery stenosis were included.

Embolic cerebral insults after transapical aortic valve implantation detected by magnetic resonance imaging.

Objectives: This study assessed the rate of periprocedural embolic ischemic brain injury during transapical aortic valve replacement in 25 consecutive patients.

Background: Transcatheter aortic valve implantation is rapidly being established as a new therapeutic approach for aortic valve stenosis. Although initial clinical results are promising, it is unknown whether mobilization and embolization of calcified particles may lead to cerebral ischemia.