Machine learning-based prediction of abdominal aortic aneurysms for individualized patient care.

Objective: The United States Preventative Services Task Force guidelines for screening for abdominal aortic aneurysms (AAA) are broad and exclude many at risk groups. We analyzed a large AAA screening database to examine the utility of a novel machine learning (ML) model for predicting individual risk of AAA.

Methods: We created a ML model to predict the presence of AAAs (>3 cm) from the database of a national nonprofit screening organization (AAAneurysm Outreach).

Unusual complication of late presentation deceleration aortic injury.

A 50-year-old patient presented with a stroke. An ascending aortic mass noted by computed tomography was attached to the aortic wall and was found to be thrombus at surgery. Pathologic examination revealed an intraluminal thrombus attached to a focal segment of intimal fragmentation.

Update of clinical echocardiographic assessment of heart failure with preserved ejection fraction.

Purpose Of Review: Heart failure with preserved ejection fraction (HFpEF) has an increasing global prevalence. Diastolic dysfunction is the predominant cause of symptoms, most commonly, exertional dyspnea. Although prevalent, the syndrome is challenging to identify due to the comorbid conditions that can present similarly.

Normally functioning quadricuspid aortic valve mistaken for bicuspid valve in a septuagenarian.

A 70-year-old male underwent transthoracic (TTE) and transesophageal (TEE) echocardiography for a stroke. A bicuspid aortic valve was suspected by TTE, but TEE revealed a normally functioning quadricuspid aortic valve. A quadricuspid aortic valve may be more common than generally thought, as it may not be readily diagnosed by TTE, and may remain functionally normal.

Evaluating the prevalence of abdominal aortic aneurysms in the United States through a national screening database.

Objective: The U.S. Preventative Services Task Force guidelines for abdominal aortic aneurysm (AAA) screening are based mainly on studies of older Caucasian males from non-U.

Radiologic chest CT findings from COVID-19 in Orleans Parish, Louisiana.

Orleans Parish in Louisiana is in the midst of an exponentially increasing number of patient admissions with COVID-19 and respiratory symptoms. Patients have been described having CT findings most consistent with an early-stage (<7 days from symptoms onset) or an advanced stage (8-14 days from symptoms onset). We describe and illustrate those early and advanced stage CT findings from patients with documented COVID-19 who have been admitted to University Medical Center in New Orleans, Louisiana.

Statistical and machine learning methodology for abdominal aortic aneurysm prediction from ultrasound screenings.

A method of analysis of a database of patients (n = 10 329) screened for an abdominal aortic aneurysm (AAA) is presented. Self-reported height, weight, age, gender, ethnicity, and parameters "Heart Problems," "Hypertension," "High Cholesterol," "Diabetes Mellitus," "Smoker Past 2 Years," "Ever Smoked?," "Family History AAA," and "Family History Brain Aneurysm" were provided. Incidence of a AAA (defined as 3 cm diameter) was calculated as a function of age and body mass index (BMI) of greater than or less than a BMI 25 for various patient groups.

The case of the missing pulmonary vein: A focused update on anomalous pulmonary venous connection in congenital cardiovascular disease.

Partial anomalous pulmonary venous connection is defined by one or more of the pulmonary veins draining to the heart into a location other than the left atrium. Depending on the location of the anomalous venous connection, they can be categorized as supracardiac, infracardiac, cardiac, and mixed types. In some cases, there is no hemodynamic consequence; in others, it can result in tricuspid regurgitation, right heart dilation, and pulmonary hypertension.

Cutis marmorata in decompression sickness is associated with a patent foramen ovale.

A 39-year-old male commercial diver developed cutis marmorata after a dive. He had a full recovery after therapy in a hyperbaric oxygen chamber. Transthoracic echocardiography revealed an atrial septal aneurysm and a large shunt during normal respirations.

Peripheral saline contrast with Valsalva and a modified Müller's maneuver may improve detection of atrial level right-to-left shunts: A preliminary observation.

As part of an evaluation for source of embolism, transthoracic echocardiography with peripheral saline contrast injection during normal respirations and also Valsalva release is routinely performed to evaluate for an atrial level shunt. We present a preliminary observation of addition of a modified Müller's maneuver early during the Valsalva release. The Müller's maneuver has been described to occur with sleep apnea and will increase right-to-left shunting through a PFO.

Identification of candidates for PFO closure in the echocardiography laboratory.

A patent foramen ovale (PFO) is implicated in several pathologic processes, including that of cryptogenic stroke (cCVA). Recent trials identify "high-risk" PFOs in patients with cCVA as likely to benefit from percutaneous closure. The younger the patient (<60 years old) the more likely a PFO may be attributable to the cCVA.

Coronary "balanced ischemia" with false negative regadenoson Technetium Tc99 m Sestamibi stress test subsequently diagnosed by FFR.

A 63-year-old female with multiple cardiovascular risk factors presented with a nontypical chest pain syndrome. Myocardial perfusion imaging (MPI) with a regadenoson (Lexiscan) Technetium Tc99 m (Sestamibi) stress test was interpreted as normal. The patient's chest pain syndrome continued, and subsequently, she presented to the emergency room.

Coronary risk assessment using traditional risk factors with computed tomography coronary artery calcium scoring: Illustrative cases.

A patient's coronary artery calcium score (CACS) is a strong independent predictor of cardiovascular risk. Used in conjunction with traditional measures of risk, the CACS helps the clinician discuss cardiovascular (CV) risk and recommend therapies with the patient. We present several cases in which measurement of the CACS and traditional risk factors were used to help guide the clinician-patient conversation and guide therapies.

Coronary risk assessment using traditional risk factors with CT coronary artery calcium scoring in clinical practice.

As coronary artery calcium (CAC) is atherosclerosis and not just a marker of cardiovascular (CV) disease, measurement of a patient's coronary artery calcium score (CACS) is a strong predictor of risk. Clinically performed in asymptomatic patients, the CACS, along with several CV risk factors, namely age, sex, ethnicity, diabetes, tobacco use, family history, cholesterol level, blood pressure, and use of cholesterol or hypertensive medications, provide a predictive model of 10 year risk for CV events. A smartphone "App" makes this quick to obtain and use.

Fractional flow reserve-CT assessment of coronary stenosis.

Coronary computed tomography angiography (CCTA) has been an established noninvasive method for detection of coronary artery disease (CAD). Although CCTA has had a high sensitivity and negative predictive value for CAD detection, specificity for obstructive CAD has been relatively low, partly due to coronary calcium, imaging artifacts, and other factors leading to an overestimation of stenosis severity. A relatively new noninvasive method of calculation of fractional flow reserve (FFR) using CCTA (FFR ) data has been developed.

Polyvalvular heart disease syndrome.

An adult case of polyvalvular heart disease syndrome diagnosed in an adult is presented. The characteristic facies and echocardiographic features of this rare autosomal dominant connective tissue disorder are presented.

Adult presentation of ALCAPA: Echo and CT diagnosis.

A healthy 20-year-old male presented with aborted sudden death. Both thoracic echocardiography and cardiac computed tomographic angiography demonstrated the characteristic findings of ALCAPA noting a dilated and tortuous right coronary artery, dilated coronary collateral arteries within the interventricular septum or along the surface of the heart, and visualization of the left coronary artery origin from the posterior aspect of the main pulmonary artery. Both imaging modalities demonstrated all three characteristic findings of this rare coronary anomaly and served as complementary imaging studies for surgical correction.

"Diagnosis" of a hiatal hernia from a CT coronary artery calcium scan.

Identification of a hiatal hernia by computed tomography (CT) scanning, and particularly with axial imaging from a coronary artery calcium score exam, is often subjective. There are several CT features that are diagnostic or at least suggestive of a hiatal hernia. As a hiatal hernia may be the etiology of a chest pain syndrome, it is important to be aware of CT findings suggestive of such.

Grade I diastolic dysfunction and elevated left ventricular end-diastolic pressure: Mitral Doppler inflow, pulmonary vein atrial reversal, and the M-mode mitral B-bump.

Grade I diastolic dysfunction (DD) is generally associated with a normal mean left atrial pressure (LAP) and normal left ventricular end-diastolic pressure (LVEDP). The first hemodynamic alteration seen in DD, however, is the development of an elevated LVEDP with a persistent normal LAP. This is manifested by echocardiography as a continued mitral pulsed wave (PW) E/A <0.

Analysis of decreases in systemic arterial pressure and heart rate in response to the hydrogen sulfide donor sodium sulfide.

The actions of hydrogen sulfide (HS) on the heart and vasculature have been extensively reported. However, the mechanisms underlying the effects of HS are unclear in the anesthetized rat. The objective of the present study was to investigate the effect of HS on the electrocardiogram and examine the relationship between HS-induced changes in heart rate (HR), mean arterial pressure (MAP), and respiratory function.

Evaluation of athletes with complex congenital heart disease.

As a result of improvements in congenital heart surgery, there are more adults alive today with congenital heart disease (CHD) than children. Individuals with cardiac birth defects may be able to participate in physical activities but require proper cardiovascular evaluation. The American Heart Association and American College of Cardiology released guidelines in 2015 for athletes with cardiovascular abnormalities.

Diagnosis of fatty liver by computed tomography coronary artery calcium score.

Nonalcoholic fatty liver disease may range from simple steatosis to fibrosis and cirrhosis. It is associated with the development of coronary artery calcification and appears to be an independent predictor of future adverse cardiovascular events. As the presence of a fatty liver appears to portray an independent increased risk, it may be beneficial to note this on coronary artery calcium scoring reports.

Cardiac CT angiography in the emergency room: Apical hypertrophic cardiomyopathy presenting as acute coronary syndrome.

A 59-year-old male presented to the emergency room with symptoms of chest tightness and palpitations. Following conversion of atrial fibrillation to sinus rhythm, he had deep symmetrical T-wave changes on his electrocardiogram. Symptoms resolved almost immediately, and his initial troponin was negative.

Complementary echo and CCTA findings with superior sinus venosus atrial septal defect.

A young female developed progressive dyspnea on minimal exertion. Echocardiography demonstrated a large right heart with severe pulmonary hypertension. Cardiac computed tomographic angiography then demonstrated a superior sinus venosus atrial septal defect with an anomalous right upper pulmonary venous drainage.

A mathematical algorithm for quantification of CT image noise.

Quantification of computed tomography (CT) noise helps in determination of radiation dosage requirements for adequate image quality. Clinical methods used include calculation of the standard deviation (SD) of a selected region of interest (ROI). In industry, wavelet decomposition has been used for image compression while removing high-frequency noise.