Left atrial functional impairment as a predictor of atrial fibrillation: insights from cardiac CT.

Objectives: A strong association exists between left atrial (LA) structural remodeling and the development of atrial fibrillation (AF). The role of LA function in AF prediction remains unclear. We studied the relationship between LA function and incident AF using cardiac CT.

Conduit Flow Compensates for Impaired Left Atrial Passive and Booster Functions in Advanced Diastolic Dysfunction.

Background: Quantification of left atrial (LA) conduit function and its contribution to left ventricular (LV) filling is challenging because it requires simultaneous measurements of both LA and LV volumes. The functional relationship between LA conduit function and the severity of diastolic dysfunction remains controversial. We studied the role of LA conduit function in maintaining LV filling in advanced diastolic dysfunction.

Comparison Between Echocardiography and Cardiac Computed Tomography in the Evaluation of Diastolic Dysfunction and Prediction of Heart Failure.

Recent data indicate that left atrial (LA) function assessment by cardiac computed tomography (CT) is closely related to diastolic dysfunction (DD). Therefore, we aimed to perform a direct comparison between CT and echocardiography for diagnosis of advanced DD and prediction of future heart failure or cardiovascular death. We identified 340 patients who had both spiral cardiac CT and a proximate echocardiogram.

Increased Rate of New-onset Left Bundle Branch Block in Patients With Bicuspid Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation (From a National Registry).

There is a growing interest in transcutaneous aortic valve implantation (TAVI) therapy among patients with bicuspid severe aortic stenosis (BAV). Conduction disturbances remain a frequent complication of TAVI, and new-onset permanent LBBB (NOP-LBBB) post-TAVI may be a marker of worse outcomes. We aimed to evaluate the rate of NOP-LBBB following TAVI among patients with BAV as compared to tricuspid severe aortic stenosis (TAV).

Left atrial function by cardiac computed tomography is a predictor of heart failure and cardiovascular death.

Objectives: We sought to evaluate cardiac CT angiography (CCTA)-based assessment of left atrial (LA) function as a predictor of hospitalizations for heart failure (HF) and cardiovascular (CV) mortality.

Methods: LA function was evaluated using automatic derivation of LA volumes to calculate LA total emptying fraction (LATEF) in 788 consecutive patients with normal sinus rhythm who had undergone spiral CT scans. The relationship between LATEF evaluated by CCTA and the composite endpoint of admission for HF or CV mortality was analyzed using Cox models.

Accuracy of Diastolic Function by Cardiac Computed Tomography Relative to Echo-Doppler: Additive Clinical and Prognostic Value.

Objectives: We aimed to assess the agreement between cardiac computed tomography (CT) and echo for diagnosing advanced diastolic dysfunction (DD) and to assess the prognostic value of CT-based parameters.

Methods: One hundred one consecutive patients who had both CT and echo-Doppler within 1 month were included. Diastolic function was assessed by CT using a previously validated method, based on left atrial volume changes, and compared with echocardiography grades 0 to 3.

Short membranous septum length in bicuspid aortic valve stenosis increases the risk of conduction disturbances.

Background: Distinct anatomical features predispose bicuspid AS patients to conduction disturbances after TAVR. This study sought to evaluate whether the incidence of permanent pacemaker implantation (PPMI) and left bundle branch block (LBBB) in patients with bicuspid aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR) is related to an anatomical association between bicuspid AS and short membranous septal (MS) length.

Methods: Sixty-seven consecutive patients with bicuspid AS from a Bicuspid AS TAVR multicenter registry and 67 propensity-matched patients with tricuspid AS underwent computed tomography before TAVR.

Risk Factors for the Development of Functional Tricuspid Regurgitation and Their Population-Attributable Fractions.

Objectives: The objective of this study was to determine risk factors for progression to hemodynamically significant tricuspid regurgitation (TR) and the population burden attributable to these risk factors.

Background: Few data are available with regard to risk factors associated with the development of hemodynamically significant functional TR.

Methods: A total of 1,552 subjects were studied beginning with an index echocardiogram demonstrating trivial or mild TR.

Lack of Increased Cardiovascular Risk due to Functional Tricuspid Regurgitation in Patients with Left-Sided Heart Disease.

Background: Significant tricuspid regurgitation (TR) is associated with higher risk for adverse cardiovascular outcomes. Left-sided heart disease (LHD) is a potentially important confounder of this association because it is strongly linked to both TR and clinical outcome.

Methods: We studied 5,886 patients who were followed for a period of 10 years after the index echocardiographic examination.

Automated 4-dimensional regional myocardial strain evaluation using cardiac computed tomography.

Evaluation of myocardial regional function is generally performed by visual "eyeballing" which is highly subjective. A robust quantifiable parameter of regional function is required to provide an objective, repeatable and comparable measure of myocardial performance. We aimed to evaluate the clinical utility of novel regional myocardial strain software from cardiac computed tomography (CT) datasets.

Tricuspid regurgitation in acute heart failure: is there any incremental risk?

Aim: Significant tricuspid regurgitation (TR) is common in heart failure (HF) and portends poor prognosis. We sought to determine whether the poor outcome results from the TR itself, or whether the TR is a surrogate marker of advanced left-sided myocardial or valvular heart disease.

Methods And Results: We studied 639 patients admitted for acute HF.

Assessment of mitral regurgitation by 3-dimensional proximal flow convergence using magnetic resonance imaging: comparison with echo-Doppler.

To test the feasibility of assessing mitral regurgitation (MR) severity using cardiac magnetic resonance (CMR) 4D velocity vectors to quantify regurgitant volume (RVol) by analysis of the proximal flow convergence, compared to Doppler based proximal isovelocity surface area (PISA) and CMR volume-based methods. In a prospectively designed study, 27 patients with various grades of MR underwent CMR and echo-Doppler on the same day. By CMR, multiple slices were obtained parallel to the mitral valve by phase-contrast imaging, using 3D velocity vectors, as well as short-axis cine images for left and right ventricular volume measurements.

[CARDIAC MAGNETIC RESONANCE AS A TOOL FOR RAPID DIAGNOSIS OF EOSINOPHILIC MYOCARDITIS].

Eosinophilic myocarditis is a rare disease with an unknown etiology, that may be severe and even lethal. Early treatment based on steroids may prevent deterioration and even lead to complete cure, but it requires rapid diagnosis. The gold standard for diagnosis of the disease is by endomyocardial biopsy but this test has low sensitivity and involves risks to the patient.

Automatic Estimation of Optimal Deployment of Transcatheter Aortic Valve Implantation Using Computed Tomography.

Background: A comparison was made between the accuracy of and time saved by using novel automated software for pre-procedural computed tomography (CT) planning before transcatheter aortic valve implantation (TAVI) and manual methods. Preprocedural CT to assess aortic annulus dimensions and predict the optimal C-arm implant angle before TAVI can reduce complications related to incorrect prosthesis sizing and positioning.

Methods: A total of 61 consecutive patients underwent TAVI using either the SAPIEN XT or CoreValve prosthesis.

Assessment of Diastolic Function in Hypertrophic Cardiomyopathy by Computed Tomography-Derived Analysis of Left Ventricular Filling.

Objectives: Hypertrophic cardiomyopathy (HCM) is characterized by diastolic dysfunction, which is difficult to assess by noninvasive methods. We hypothesized that measurement of simultaneous left ventricular (LV) and left atrial (LA) volume changes by cardiac computed tomography would be useful in the assessment of diastolic function in HCM.

Methods: We studied 21 patients with HCM and 21 age-matched controls.

Time Dependence of the Effect of Right Ventricular Dysfunction on Clinical Outcomes After Myocardial Infarction: Role of Pulmonary Hypertension.

Background: The clinical importance of right ventricular (RV) function in acute myocardial infarction is well recognized, but the impact of concomitant pulmonary hypertension (PH) has not been studied.

Methods And Results: We studied 1044 patients with acute myocardial infarction. Patients were classified into 4 groups according to the presence or absence of RV dysfunction and PH, defined as pulmonary artery systolic pressure >35 mm Hg: normal right ventricle without PH (n=509), normal right ventricle and PH (n=373), RV dysfunction without PH (n=64), and RV dysfunction and PH (n=98).

Impact of computed tomography image and contact force technology on catheter ablation for atrial fibrillation.

Aim: To investigate the impact of using computed tomography (CT) and contact force (CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation (AF) ablation.

Methods: This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication.

Left-sided cardiac chamber evaluation using single-phase mid-diastolic coronary computed tomography angiography: derivation of normal values and comparison with conventional end-diastolic and end-systolic phases.

Objectives: With increasing use of prospective scanning techniques for cardiac computed tomography (CT), meaningful evaluation of chamber volumes is no longer possible due to lack of normal values. We aimed to define normal values for mid-diastolic (MD) chamber volumes and to determine their significance in comparison to maximum volumes.

Methods: Normal ranges at MD for left ventricular (LV) volume and mass and left atrial (LA) volume were determined from 101 normal controls.

Outflow tract ventricular arrhythmia originating from the aortic cusps: our approach for challenging ablation.

Background: Ablation of outflow flow ventricular arrhythmia (VA) originating from aortic cusps can be challenging. The aim of this study was to describe our approach for this ablation.

Methods: All patients with outflow VA suspected to originate from aortic cusps according to ECG or after failed ablation from right ventricular outflow tract (RVOT) underwent cardiac CT and radiofrequency ablation.