Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) in Uncomplicated Type B Aortic Dissection: Study Design and Rationale.

Purpose: To describe the design and methodological approach of a multicenter, retrospective study to externally validate a clinical and imaging-based model for predicting the risk of late adverse events in patients with initially uncomplicated type B aortic dissection (uTBAD).

Materials And Methods: The Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) is a collaboration between 10 academic aortic centers in North America and Europe. Two centers have previously developed and internally validated a recently developed risk prediction model.

Inter-observer variability of expert-derived morphologic risk predictors in aortic dissection.

Objectives: Establishing the reproducibility of expert-derived measurements on CTA exams of aortic dissection is clinically important and paramount for ground-truth determination for machine learning.

Methods: Four independent observers retrospectively evaluated CTA exams of 72 patients with uncomplicated Stanford type B aortic dissection and assessed the reproducibility of a recently proposed combination of four morphologic risk predictors (maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and intercostal arteries). For the first inter-observer variability assessment, 47 CTA scans from one aortic center were evaluated by expert-observer 1 in an unconstrained clinical assessment without a standardized workflow and compared to a composite of three expert-observers (observers 2-4) using a standardized workflow.

Randomized Trial Comparing Standard Versus Ultrasound-Assisted Thrombolysis for Submassive Pulmonary Embolism: The SUNSET sPE Trial.

Objectives: The aim of this trial was to determine whether ultrasound-assisted thrombolysis (USAT) is superior to standard catheter-directed thrombolysis (SCDT) in pulmonary arterial thrombus reduction for patients with submassive pulmonary embolism (sPE).

Background: Catheter-directed therapy has been increasingly used in sPE and massive pulmonary embolism as a decompensation prevention and potentially lifesaving procedure. It is unproved whether USAT is superior to SCDT using traditional multiple-side-hole catheters in the treatment of patients with pulmonary embolism.

Computed Tomography Aortic Valve Calcium Scoring in Patients With Aortic Stenosis.

Background: Computed tomography aortic valve calcium scoring (CT-AVC) holds promise for the assessment of patients with aortic stenosis (AS). We sought to establish the clinical utility of CT-AVC in an international multicenter cohort of patients.

Methods And Results: Patients with AS who underwent ECG-gated CT-AVC within 3 months of echocardiography were entered into an international, multicenter, observational registry.

Design and rationale of a randomized trial comparing standard versus ultrasound-assisted thrombolysis for submassive pulmonary embolism.

Background: Catheter-directed interventions for the treatment of patients with submassive pulmonary embolism (sPE) have shown promise in rapidly improving right-sided heart strain and preventing decompensation to massive pulmonary embolism. Among various catheter interventions, ultrasound-assisted thrombolysis (USAT) has attracted interest as potentially having more efficient lytic effect that could achieve thrombolysis faster and with a reduced lytic dose. However, based on clinical evidence, it is unclear whether USAT is superior to standard catheter-directed thrombolysis (SCDT).

Granulomatosis with Polyangiitis Presenting with Coronary Artery and Pericardial Involvement.

Granulomatosis with polyangiitis is a systemic disease resulting in necrotizing vasculitis of small- and medium-sized vessels. Cardiac involvement is rare and when present usually manifests with pericarditis and coronary artery vasculitis. We report here a case of granulomatosis with polyangiitis involving the native coronary arteries, bypass graft, and pericardium with interesting imaging findings on contrast-enhanced CT and MRI.

Aggressive Aortic Arch and Carotid Replacement Strategy for Type A Aortic Dissection Improves Neurologic Outcomes.

Background: International registries for acute type A aortic dissection (TAAD) demonstrate stagnant operative mortality rates in excess of 20% and stroke rates of 9% to 25%, with little global emphasis on stroke reduction or carotid involvement. Cerebral malperfusion with TAAD has been linked to poorer outcome. We hypothesize that concomitant carotid dissection or complex dissection flaps in the arch play a major role in stroke development and that aggressive reconstruction of the arch and carotid arteries can improve neurologic outcomes in TAAD.

RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension.

Objective: Prognosis in pulmonary hypertension (PH) is largely determined by RV function. However, uncertainty remains about what metrics of RV function might be most clinically relevant. The purpose of this study was to assess the clinical relevance of metrics of RV functional adaptation to increased afterload.

Computed tomographic analysis of left ventricular volumes and function after implantation of the Parachute® endoventricular partitioning device.

Background: Preliminary clinical experience with a percutaneous endoventricular partitioning device (Parachute®, CardioKinetix Inc., Menlo Park, CA, USA) suggests that it ameliorates global LV dysfunction and heart failure symptoms in selected patients who have suffered previous anterior myocardial infarction. Less is known of its effect on regional LV function.

Post occlusive left atrial appendage thrombosis with extension into the left atrium.

A 67-year-old man underwent left atrial appendage (LAA) exclusion concomitant with mitral valve surgery and radiofrequency ablation maze procedure. On transoesophageal echocardiography anticipating ablation for left atrial tachycardia, an echodense thrombus was visualised in the LAA location with apparent intracavitary extension into the left atrium. Based on CT imaging findings, the echo represented thrombosis of a large left atrial appendage with probable extension into the left atrium.

The role of aortic wall CT attenuation measurements for the diagnosis of acute aortic syndromes.

Objectives: To determine if measurements of aortic wall attenuation can improve the CT diagnosis of acute aortic syndromes.

Methods: CT reports from a ten year period were searched for acute aortic syndromes (AAS). Studies with both an unenhanced and a contrast enhanced (CTA) series that had resulted in the diagnosis of intramural hematoma (IMH) were reviewed.

Free-breathing, motion-corrected late gadolinium enhancement is robust and extends risk stratification to vulnerable patients.

Background: Routine clinical use of novel free-breathing, motion-corrected, averaged late-gadolinium-enhancement (moco-LGE) cardiovascular MR may have advantages over conventional breath-held LGE (bh-LGE), especially in vulnerable patients.

Methods And Results: In 390 consecutive patients, we collected bh-LGE and moco-LGE with identical image matrix parameters. In 41 patients, bh-LGE was abandoned because of image quality issues, including 10 with myocardial infarction.

Effectiveness of late gadolinium enhancement to improve outcomes prediction in patients referred for cardiovascular magnetic resonance after echocardiography.

Background: Echocardiography (echo) is a first line test to assess cardiac structure and function. It is not known if cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) ordered during routine clinical practice in selected patients can add additional prognostic information after routine echo. We assessed whether CMR improves outcomes prediction after contemporaneous echo, which may have implications for efforts to optimize processes of care, assess effectiveness, and allocate limited health care resources.

Prevalence of aortic root dilation in patients with CT angiography of the aorta.

Purpose: To investigate the prevalence of aortic root dilation in patients who underwent CT angiography of the thoracic aorta.

Materials And Methods: In 95 patients, 64-slice multislice computed tomography was performed for evaluation of the thoracic aorta. Measurements of the annulus, sinuses of valsalva (SOV), sinotubular junction (STJ), and maximum ascending aorta (AAo) were made by double oblique multiplanar reformation (MPR).

Phenotyping the right ventricle in patients with pulmonary hypertension.

Right ventricular (RV) failure is associated with poor outcomes in pulmonary hypertension (PH). We sought to phenotype the RV in PH patients with compensated and decompensated RV function by quantifying regional and global RV structural and functional changes. Twenty-two patients (age 51 +/- 11, 14 females, mean pulmonary artery (PA) pressure range 13-79 mmHg) underwent right heart catheterization, echocardiography, and ECG-gated multislice computed tomography of the chest.

Compare display schemes for lung nodule CT screening.

This study investigated the relative efficiencies of a stereographic display and two monoscopic display schemes for detecting lung nodules in chest computed tomography (CT). The ultimate goal was to determine whether stereoscopic display provides advantages for visualization and interpretation of three-dimensional (3D) medical image datasets. A retrospective study that compared lung nodule detection performances achieved using three different schemes for displaying 3D CT data was conducted.

Focal monomorphic ventricular tachycardia as the first manifestation of amyloid cardiomyopathy.

52-year-old patient presented with palpitation and well tolerated monomorphic ventricular tachycardia. He had normal echocardiogram and coronary angiogram 3 months prior to presentation. Surface EKG revealed regular wide-complex tachycardia with right bundle branch block morphology and right inferior axis.

The aortic root: comparison of measurements from ECG-gated CT angiography with transthoracic echocardiography.

Purpose: The purpose of this study was to compare the measurements of the aortic root obtained from electrocardiographically (ECG)-gated computed tomography (CT) angiography (CTA) to the measurements obtained from transthoracic echocardiography (TTE).

Materials And Methods: This was a retrospective study in a patient population scanned at our institution between December 2005 and January 2007 with retrospectively ECG-gated CTA. ECG-gated CTA was performed with a 64-section helical CT scanner (Light speed, VCT, GE, Milwaukee, WI).

Extra Atrial Disease in Patients with "Lone" Atrial Fibrillation.

Aims: Lone atrial fibrillation (LAF) is considered by some to be a primary atrial electrophysiologic disorder. However, we have frequently observed evidence of "extraatrial" diseases - atherosclerosis and associated metabolic disorders - in our LAF patients. We sought to characterize and quantify extraatrial disease burden in LAF patients, and to correlate this burden with features of the arrhythmia including pattern (paroxysmal versus persistent) and response to catheter ablation.

Dynamic multidimensional imaging of the human left atrial appendage.

Aims: The human left atrial appendage (LAA) is a region of increasing interest as a target for intervention. We sought to improve insight into the anatomy of this region using computed tomography (CT).

Methods And Results: Multidimensional cardiac reconstruction (whole heart and isolated left atrium) from CT images was performed in each of three groups: (i) patients without atrial fibrillation (AF, n =10); (ii) patients with intermittent (paroxysmal) AF (n = 25); (iii) patients with continuous (persistent) AF (n = 10).

Characterization of radiologists' search strategies for lung nodule detection: slice-based versus volumetric displays.

The goal of this study was to assess whether radiologists' search paths for lung nodule detection in chest computed tomography (CT) between different rendering and display schemes have reliable properties that can be exploited as an indicator of ergonomic efficiency for the purpose of comparing different display paradigms. Eight radiologists retrospectively viewed 30 lung cancer screening CT exams, containing a total of 91 nodules, in each of three display modes [i.e.

On the accuracy of CartoMerge for guiding posterior left atrial ablation in man.

Background: Recent reports suggest that the CartoMerge system is useful for guiding human posterior left atrial (PLA) endocardial ablation.

Objective: To assess the accuracy of the CartoMerge system during PLA ablation.

Methods: Sixteen patients undergoing PLA catheter ablation were studied.

CT of the pulmonary veins.

Atrial fibrillation (AF) is a common cardiac rhythm disturbance and its incidence is increasing. Radiofrequency catheter ablation (RFCA) is a highly successful therapy for treating AF, and its use is becoming more widespread; however, with its increasing use and evolving technique, known complications are better understood and new complications are emerging. Computed tomography (CT) of the pulmonary veins, or more correctly, the posterior left atrium (LA), has an established role in precisely defining the complex anatomy of the LA and pulmonary veins preablation and has an expanding role in identifying the myriad of possible complications postablation.

A novel two-dimensional echocardiographic image analysis system using artificial intelligence-learned pattern recognition for rapid automated ejection fraction.

Objectives: We sought to test the hypothesis that a novel 2-dimensional echocardiographic image analysis system using artificial intelligence-learned pattern recognition can rapidly and reproducibly calculate ejection fraction (EF).

Background: Echocardiographic EF by manual tracing is time consuming, and visual assessment is inherently subjective.

Methods: We studied 218 patients (72 female), including 165 with abnormal left ventricular (LV) function.