Stella-Lida Papadopoulou

Aortic annulus dimensions and leaflet calcification from contrast MSCT predict the need for balloon post-dilatation after TAVI with the Medtronic CoreValve prosthesis

AIMS We compared the measurement of aortic leaflet calcification on contrast and non-contrast MSCT and investigated predictors of the need for balloon post-dilatation after TAVI. METHODS AND RESULTS In 110 patients, who had TAVI with a Medtronic CoreValve prosthesis (MCS) for symptomatic aortic stenosis, calcification of the aortic root was measured on non-contrast MSCT (conventionally) and on contrast MSCT (signal attenuation >450 Houndsfield units). Calcium volume was underestimated on contrast- when compared to non-contrast MSCT: median (IQ-range)=759 (466 to 1295) vs. 2016 (1376 to 3262) and the difference between the two methods increased with higher calcium volumes (correlation coefficient r=0.90). Calcium mass was only slightly underestimated on contrast vs. non-contrast MSCT: median (IQ-range)=441 (268 to 809) vs. 555 (341 to 950) and there was no association between the differences and increasing calcium mass (r=0.17). Balloon post-dilatation was performed for significant aortic regurgitation after TAVI in 11 of 110 patients. When compared to controls, the patients who required balloon post-dilatation had higher aortic leaflet calcium on contrast CT (p<0.01), higher aortic annulus diameters (p<0.01) and higher annulus to prosthesis area ratio (p=0.01). ROC curves demonstrated that aortic root or aortic leaflet calcium measured on either contrast- or non-contrast MSCT showed excellent discrimination for the requirement of balloon post-dilatation (area under ROC >0.80 for all), whereas the discriminatory value of aortic annulus dimensions was moderate (area under ROC=0.69) and that of prosthesis to annulus ratio was poor (area under ROC=0.36). CONCLUSIONS Dense aortic leaflet calcification measured on contrast MSCT discerned well the need for balloon post-dilatation after TAVI with an MCS for significant PAR. Non-contrast MSCT may no longer be needed to quantify aortic root calcium before TAVI.

CT-SYNTAX score: A feasibility and reproducibility study

The SYNTAX score (SXscore) ([1][1]) is an important tool to grade angiographic complexity and to risk-stratify patients being considered for revascularization; moreover, it has been reported as an independent predictor of major adverse cardiac events in all-comers–type populations with a varying

Quantitative Computed Tomographic Coronary Angiography Does It Predict Functionally Significant Coronary Stenoses

Background—Coronary lesions with a diameter narrowing ≥50% on visual computed tomographic coronary angiography (CTCA) are generally considered for referral to invasive coronary angiography. However, similar to invasive coronary angiography, visual CTCA is often inaccurate in detecting functionally significant coronary lesions. We sought to compare the diagnostic performance of quantitative CTCA with visual CTCA for the detection of functionally significant coronary lesions using fractional flow reserve (FFR) as the reference standard. Methods and Results—CTCA and FFR measurements were obtained in 99 symptomatic patients. In total, 144 coronary lesions detected on CTCA were visually graded for stenosis severity. Quantitative CTCA measurements included lesion length, minimal area diameter, % area stenosis, minimal lumen diameter, % diameter stenosis, and plaque burden [(vessel area−lumen area)/vessel area×100]. Optimal cutoff values of CTCA-derived parameters were determined, and their diagnostic accuracy for the detection of flow-limiting coronary lesions (FFR ⩽0.80) was compared with visual CTCA. FFR was ⩽0.80 in 54 of 144 (38%) coronary lesions. Optimal cutoff values to predict flow-limiting coronary lesion were 10 mm for lesion length, 1.8 mm2 for minimal area diameter, 73% for % area stenosis, 1.5 mm for minimal lumen diameter, 48% for % diameter stenosis, and 76% for plaque burden. No significant difference in sensitivity was found between visual CTCA and quantitative CTCA parameters (P>0.05). The specificity of visual CTCA (42%; 95% confidence interval [CI], 31%–54%) was lower than that of minimal area diameter (68%; 95% CI, 57%–77%; P=0.001), % area stenosis (76%; 95% CI, 65%–84%; P<0.001), minimal lumen diameter (67%; 95% CI, 55%–76%; P=0.001), % diameter stenosis (72%; 95% CI, 62%–80%; P<0.001), and plaque burden (63%; 95% CI, 52%–73%; P=0.004). The specificity of lesion length was comparable with that of visual CTCA. Conclusions—Quantitative CTCA improves the prediction of functionally significant coronary lesions compared with visual CTCA assessment but remains insufficient. Functional assessment is still required in lesions of moderate stenosis to accurately detect impaired FFR.

Quantitative CT Coronary Angiography: Does It Predict Functionally Significant Coronary Stenoses?

Background—Coronary lesions with a diameter narrowing ≥50% on visual computed tomographic coronary angiography (CTCA) are generally considered for referral to invasive coronary angiography. However, similar to invasive coronary angiography, visual CTCA is often inaccurate in detecting functionally significant coronary lesions. We sought to compare the diagnostic performance of quantitative CTCA with visual CTCA for the detection of functionally significant coronary lesions using fractional flow reserve (FFR) as the reference standard. Methods and Results—CTCA and FFR measurements were obtained in 99 symptomatic patients. In total, 144 coronary lesions detected on CTCA were visually graded for stenosis severity. Quantitative CTCA measurements included lesion length, minimal area diameter, % area stenosis, minimal lumen diameter, % diameter stenosis, and plaque burden [(vessel area−lumen area)/vessel area×100]. Optimal cutoff values of CTCA-derived parameters were determined, and their diagnostic accuracy for the detection of flow-limiting coronary lesions (FFR ⩽0.80) was compared with visual CTCA. FFR was ⩽0.80 in 54 of 144 (38%) coronary lesions. Optimal cutoff values to predict flow-limiting coronary lesion were 10 mm for lesion length, 1.8 mm2 for minimal area diameter, 73% for % area stenosis, 1.5 mm for minimal lumen diameter, 48% for % diameter stenosis, and 76% for plaque burden. No significant difference in sensitivity was found between visual CTCA and quantitative CTCA parameters (P>0.05). The specificity of visual CTCA (42%; 95% confidence interval [CI], 31%–54%) was lower than that of minimal area diameter (68%; 95% CI, 57%–77%; P=0.001), % area stenosis (76%; 95% CI, 65%–84%; P<0.001), minimal lumen diameter (67%; 95% CI, 55%–76%; P=0.001), % diameter stenosis (72%; 95% CI, 62%–80%; P<0.001), and plaque burden (63%; 95% CI, 52%–73%; P=0.004). The specificity of lesion length was comparable with that of visual CTCA. Conclusions—Quantitative CTCA improves the prediction of functionally significant coronary lesions compared with visual CTCA assessment but remains insufficient. Functional assessment is still required in lesions of moderate stenosis to accurately detect impaired FFR.

Transaortic flow velocity from dual‐source MDCT for the diagnosis of aortic stenosis severity

To describe a method for the estimation of transaortic flow from multidetector computer tomography (MDCT).

Noninvasive Prediction of Atherosclerotic Progression: The PROSPECT-MSCT Study

Intravascular imaging-based natural history studies of atherosclerosis have provided insight into atherosclerotic evolution and demonstrated that local hemodynamic factors, plaque burden, and the composition of the atheroma regulate plaque growth and determine vulnerable plaque formation [(1,2)][1

A CT-based medina classification in coronary bifurcations: Does the lumen assessment provide sufficient information?

To evaluate the distribution of atherosclerosis at bifurcations with computed tomography coronary angiography (CTCA) and propose a novel CT‐Medina classification for bifurcation lesions.

Patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation: advanced echocardiographic evaluation of the left atrium combined with non-invasive P-wave analysis

AIMS The maintenance of sinus rhythm is crucial for the functional capacity of patients with hypertrophic cardiomyopathy (HCM). Using a multimodality approach, we attempted to identify potential predictors of paroxysmal atrial fibrillation (PAF) in HCM patients. METHODS AND RESULTS Thirty HCM patients (17 males, mean age 57.9 ± 13.6) with at least one documented PAF episode and 32 age- and sex-matched HCM control patients as well as 25 healthy volunteers were studied in sinus rhythm. Study subjects underwent 2D echocardiography including a colour Doppler myocardial imaging evaluation of the left atrium (LA). Additionally, an orthogonal electrocardiogram was acquired; P-wave duration, maximum, and mean energies were calculated for each subject at each orthogonal lead and the composite vector axis using the Morlet wavelet analysis. Compared with HCM controls, in HCM-PAF patients, LA antero-posterior diameter was significantly enlarged (LADAP: 46.1 ± 5.9 vs. 40.0 ± 4.7 mm, P < 0.001), peak strain rate of the LA lateral wall in the reservoir phase was significantly decreased (LAT peak SR-S: 1.93 ± 0.51 vs. 2.55 ± 0.83 s(-1), P < 0.01), and P-wave duration in the Z-lead was significantly prolonged (P-durZ: 106.9 ± 24.6 vs. 86.2 ± 14.3 ms, P < 0.001). Cut-off values and areas under the curve (AUCs) for individual parameters were 42.0 mm, 2.32 s(-1), and 98.8 ms and 0.81, 0.74, and 0.78, respectively. A multivariable model combining LADAP, LAT peak SR-S and P-durZ had an AUC of 0.90, a sensitivity of 0.87, and a specificity of 0.91 for identifying PAF patients. CONCLUSION P-wave duration combined with LA antero-posterior diameter and myocardial deformation indices resulted in a higher power for discriminating HCM-PAF patients, when compared with individual parameters derived from either wavelet analysis or 2D echocardiography.

Acute Pericarditis as a Rare Presentation of Cardiac Involvement in Sarcoidosis

Sarcoidosis is a chronic systemic disease without any identified etiology. In general, it affects the lungs and lymph nodes, but can implicate any other organ. Cardiac involvement in patients with systemic sarcoidosis is usually the cause of death.1 Usually, patients present with complete heart block, bundle branch block, ventricular tachycardia (VT), congestive heart failure, and/or sudden death.2 The myocardium and, to a lesser extent, the endocardium are usually involved. Pericardial involvement often presents as moderate to large pericardial effusion detected in echocardiography.3 We here present a case of symptomatic acute pericarditis, which is a rare manifestation of cardiac involvement in sarcoidosis.1,4,5

The effect of coronary bifurcation and haemodynamics in prediction of atherosclerotic plaque development: a serial computed tomographic coronary angiographic study.

AIMS The aim of this study was to examine the effect of the daughter branches on the haemodynamics and the potential prediction of atherosclerotic plaque development as well as the best flow division model for accurate blood flow modelling. METHODS AND RESULTS We analysed computed tomography coronary angiography retrospective data portraying 17 coronary artery bifurcations in 15 patients recruited into the PROSPECT MSCT study. Baseline and three-year follow-up imaging data were used to reconstruct coronary artery anatomy. In the baseline models blood flow simulations were performed using three flow division approaches: stress-free, Murrays law and Doriots fit. Blood flow simulation was also performed omitting the daughter branch. The association between ESS estimated in models that incorporated the daughter branches and lumen reduction was higher than the cases where the side branch was omitted. Murrays law provides the most accurate results when comparing the different flow division models. More specifically, low ESS is a predictor of significant lumen reduction (p=0.007), plaque burden increase (p=0.0006) and necrotic core change (p=0.025). CONCLUSIONS The ESS distribution in coronary models including the daughter branches and based on the calculations implementing Murrays law allows more accurate prediction of atherosclerotic evolution than ESS estimated in models including only the main vessel.