Evaluating the role of left ventricle global longitudinal strain in myocardial perfusion defect assessment.

Myocardial perfusion defect, assessed with single photon emission computed tomography (SPECT), is useful for patient management and risk stratification. Left ventricle Global Longitudinal Strain (LV GLS) has gained interest for observing subclinical LV dysfunction. We aimed to investigate the utility of LV GLS in evaluating myocardial perfusion defect.

Cardiac Gated Computed Tomography Angiography Discloses a Correlation Between the Volumes of All Four Cardiac Chambers and Heart Rate in Men But Not in Women.

Currently, normal values of the cardiac chambers' volumes are adjusted only for gender and body surface area (BSA). We aim to investigate the association between the heart rate and the volume of each of the four cardiac chambers using cardiac-gated computed tomography angiography (CCTA). A total of 350 consecutive patients without known cardiac diseases or significant (>50%) stenosis undergoing CCTA between January 2009 and June 2014 for suspected coronary artery disease were included.

Infected Thrombus on a TAVI Aortic Valve.

After a series of tests, an 86-year-old patient was shown to have an infected thrombus on a TAVI valve and was referred to urgent surgery. The valve with the infected thrombus was removed and a biological prosthetic valve was implanted in its place.

Re-introducing immunotherapy in patients surviving immune checkpoint inhibitors-mediated myocarditis.

Background: Immune checkpoint inhibitors (ICI) have transformed the standard care of cancer treatment. Recent case reports describe ICI-mediated myocarditis with an atypical presentation and fatal potential which lead to permanent interruption of immunotherapy.

Objectives: To characterize ICI-mediated myocarditis and re-introduction to immunotherapy.

Long-term implications of left atrial appendage thrombus identified incidentally by pre-procedural cardiac computed tomography angiography in patients undergoing transcatheter aortic valve replacement.

Aims: The prevalence and prognostic implications of left atrial appendage (LAA) thrombus (LAAT) in patients considered for transcatheter aortic valve replacement (TAVR) are incompletely defined. We, therefore, studied pre-procedural cardiac computed tomography angiography (CCTA) scans of TAVR candidates to determine the prevalence of LAAT and its association with late outcomes.

Methods And Results: Baseline clinical variables and CCTA findings from a prospective TAVR registry were analysed for the prevalence of pre-procedural LAAT and its impact on in-hospital outcomes and late mortality.

A case report of arrhythmogenic ventricular cardiomyopathy presenting with sustained ventricular tachycardia arising from the right and the left ventricles before structural changes are documented.

Background: Arrhythmogenic ventricular cardiomyopathy (AC) is a genetic progressive disease characterized by fibro-fatty replacement of either ventricles in isolation or in combination. Arrhythmogenic ventricular cardiomyopathy is frequently associated with ventricular tachycardia (VT) having a left bundle branch block (LBBB) morphology and much more rarely with VT having right bundle branch block (RBBB) morphology even when the left ventricle is involved. Cardiac magnetic resonance (CMR) imaging plays a key role in the diagnosis of AC.

Impact of right ventricular volumes on the outcomes of TAVR: a volumetric analysis of preprocedural computed tomography.

Aims: The aim of this study was to assess the prognostic implications of increased right ventricle volume index (RVVI) using cardiac-gated computed tomography angiography (CCTA) data among patients undergoing transcatheter valve replacement (TAVR).

Methods And Results: CCTA of 323 patients who underwent TAVR at Stanford University Medical Center (CA, USA) and Tel Aviv Medical Center (Israel) between 2013 and 2016 was analysed by an automatic four-chamber volumetric software and grouped into quartiles according to RVVI. Higher one-year mortality rates were noted for the upper quartiles - 5%, 4.

Shift Work and the Risk of Coronary Artery Disease: A Cardiac Computed Tomography Angiography Study.

Aims: Shift work disrupts the normal circadian rhythm and is associated with risk factors for coronary artery disease (CAD) and a higher incidence of CAD morbidity and mortality. Cardiac computed tomography angiography (CCTA) is a robust noninvasive modality for assessing the presence, extent, and severity of CAD. We sought to investigate whether shift workers are prone to a higher burden of CAD compared to non-shift workers.

An association between volumes of the cardiac chambers and troponin levels in individuals submitted to cardiac coronary computed tomography.

Background: Previous echocardiographic studies have revealed an association between enlarged cardiac chamber volumes and elevated troponin concentrations. An automatic 4-chamber volumetric analysis tool was adopted to investigate this association in patients who underwent cardiac-gated computed tomography angiography (CCTA).

Hypothesis: We hypothesized that troponin concentration within the normal range correlates with cardiac chambers' volumes.

Aortoventricular annulus shape as a predictor of pacemaker implantation following transcatheter aortic valve replacement.

Aims: Conduction abnormalities following transcatheter aortic valve replacement (TAVR) are caused by damage of the aortoventricular conduction tissue during positioning of the valve. Therefore, our aim was to assess whether a higher difference between the long and short diameters of the elliptic aortoventricular annulus will possess higher forces on the annulus, and thus will be a predictor of pacemaker need following TAVR.

Methods: We retrospectively analyzed 123 patients who had the aortoventricular annulus measured by computed tomography angiography.

Use of New Imaging CARTO® Segmentation Module Software to Facilitate Ablation of Ventricular Arrhythmias.

Introduction: A new imaging software (CARTO® Segmentation Module, Biosense Webster) allows preprocedural 3-D reconstruction of all heart chambers based on cardiac CT. We describe our initial experience with the new module during ablation of ventricular arrhythmias.

Methods And Results: Eighteen consecutive patients with idiopathic ventricular arrhythmias or ischemic ventricular tachycardia (VT) were studied.

Left atrial appendage and pulmonary artery anatomic relationship by cardiac-gated computed tomography: Implications for late pulmonary artery perforation by left atrial appendage closure devices.

Background: Delayed pulmonary artery (PA) perforation and tamponade caused by implantable left atrial appendage (LAA) closure devices has been reported in patients with close proximity between these structures. The LAA and PA anatomic relationship (LAA-PAar) has not been analyzed systematically.

Objective: The purpose of this study was to identify LAA-PAar variants potentially susceptible to this complication using cardiac-gated computed tomography angiography.

Steroid therapy and conduction disturbances after transcatheter aortic valve implantation.

Background: Direct mechanical compression of the frame struts on the adjacent bundle branch with local inflammatory reaction might cause conduction system disturbances and need for pacemaker implantation following transcatheter aortic valve implantation (TAVI). We assessed the impact of preprocedural anti-inflammatory steroid therapy on the occurrence of conduction disturbances following TAVI.

Methods And Results: From a cohort of 324 patients who underwent transfemoral TAVI, 39 (12%) were pretreated with steroids because of iodine allergy (n=29) or active obstructive pulmonary disease (n=10).

Incremental value of diagonal earlobe crease to the Diamond-Forrester classification in estimating the probability of significant coronary artery disease determined by computed tomographic angiography.

The Diamond-Forrester (DF) algorithm overestimates the likelihood of significant coronary artery disease (≥50% stenosis, CAD50). The aim of the present study was to evaluate whether the addition of a diagonal earlobe crease (DELC) enhances the predictive ability of DF to detect CAD50 by coronary computed tomographic angiography (CTA). We evaluated 430 patients referred for CTA for symptoms, cardiovascular risk factors, and CAD50 likelihood using DF.

Optimizing image contrast display improves quantitative stenosis measurement in heavily calcified coronary arterial segments on coronary CT angiography: A proof-of-concept and comparison to quantitative invasive coronary angiography.

Rationale And Objectives: Blooming artifact from calcified plaques often renders measurement of stenosis impossible on coronary computed tomographic angiography (CTA). We sought to evaluate the impact of modifying window level on reducing blooming artifact, and its impact on stenosis quantification.

Materials And Methods: We analyzed 125 calcified segments from 53 patients who underwent CTA and invasive coronary angiography (ICA).

Relationship of epicardial fat volume to coronary plaque, severe coronary stenosis, and high-risk coronary plaque features assessed by coronary CT angiography.

Background: Associations of epicardial fat volume (EFV) measured on noncontrast cardiac CT (NCT) include coronary plaque, myocardial ischemia, and adverse cardiac events.

Objectives: This study aimed to define the relationship of EFV to coronary plaque type, severe coronary stenosis, and the presence of high-risk plaque features (HRPFs).

Methods: We retrospectively evaluated 402 consecutive patients, with no prior history of coronary artery disease, who underwent same day NCT and coronary CT angiography (CTA).

Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography.

Controversy exists concerning the relation between diagonal ear lobe crease (DELC) and coronary artery disease (CAD). We examined whether DELC is associated with CAD using coronary computed tomography (CT) angiography. We studied 430 consecutive patients without a history of coronary artery intervention who underwent CT angiography on a dual-source scanner.

Weight change modulates epicardial fat burden: a 4-year serial study with non-contrast computed tomography.

Introduction: Epicardial fat volume (EFV) is linked to cardiovascular event risk. We aimed to investigate the relationships between EFV and weight change.

Methods: From the EISNER (Early Identification of Subclinical Atherosclerosis using Non-invasive Imaging Research) Registry with baseline and follow-up coronary calcium scans (1248 subjects), we selected a cohort of 374 asymptomatic subjects matched using age decade, gender and coronary calcium score (CCS) as a measure of subclinical cardiovascular risk, who underwent 2 scans at an interval of 4.

Threshold for the upper normal limit of indexed epicardial fat volume: derivation in a healthy population and validation in an outcome-based study.

Epicardial fat volume (EFV) quantified on noncontrast cardiac computed tomography relates to cardiovascular prognosis. We sought to define the upper normal limit of body surface area (BSA)-indexed EFV (EFVi) in a healthy population and to validate it as a predictor of major adverse cardiovascular events (MACE). We analyzed noncontrast cardiac computed tomography scans of 226 healthy subjects with a low Framingham Risk Score (FRS; ≤6%) performed for coronary calcium scoring (CCS).

Vulnerable plaque features on coronary CT angiography as markers of inducible regional myocardial hypoperfusion from severe coronary artery stenoses.

Objective: We explored whether the presence of 3 known features of plaque vulnerability on coronary CT angiography (CCTA)--low attenuation plaque content (LAP), positive remodeling (PR), and spotty calcification (SC)--identifies plaques associated with greater inducible myocardial hypoperfusion measured by myocardial perfusion imaging (MPI).

Methods: We analyzed 49 patients free of cardiac disease who underwent CCTA and MPI within a 6-month period and were found on CCTA to have focal 70-99% stenosis from predominantly non-calcified plaque in the proximal or mid segment of 1 major coronary artery. Presence of LAP (≤ 30 Hounsfield Units), PR (outer wall diameter exceeds proximal reference by ≥ 5%), and SC (≤ 3 mm long and occupies ≤ 90° of cross-sectional artery circumference) was determined.

Increase in epicardial fat volume is associated with greater coronary artery calcification progression in subjects at intermediate risk by coronary calcium score: a serial study using non-contrast cardiac CT.

Objective: Epicardial fat volume (EFV) is related to calcified coronary plaques. However, it is unknown whether baseline EFV or changes in EFV affect the progression of coronary artery calcification over time.

Methods: We identified 375 consecutive asymptomatic subjects with an intermediate risk of developing coronary artery disease, who underwent serial non-contrast CT at least 3-5 years apart.

The relationship between epicardial fat volume and incident coronary artery calcium.

Background: Epicardial fat volume (EFV) has been associated with prevalent but not incident coronary artery calcium. However, the relationship between EFV and development of incident coronary calcium (incCC) has not been reported.

Objective: We evaluated the relationship between epicardial fat volume and the development of coronary artery calcium over 3-5 years.