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Cardiac imaging is the backbone for safe and optimal transcatheter structural interventions. Transthoracic echocardiogram is the initial modality to assess valvular disorders, while transesophageal echocardiogram is best to delineate the mechanism of valvular regurgitation, preprocedural assessment for transcatheter edge-to-edge repair, and for intraprocedural guidance. Cardiac computed tomography is the modality of choice for assessing calcifications, maneuvering multiplaner reconstruction of different cardiac structures, preprocedural planning for various transcatheter valve replacement, and assessing for hypoattenuated leaflet thickening and reduced leaflet motion. Cardiac magnetic resonance imaging is best known for most accurate volumetric assessment of valvular regurgitation and chamber size quantification. Cardiac positron emission tomography is the only modality that could assess active infection through using fluorine 18 fluorodeoxyglucose radiotracer. [ABSTRACT FROM AUTHOR]

The article discusses the use of left ventricular assist devices (LVADs) in treatment of heart diseases and role of echocardiography in determination of complication associated with the device dysfunction. It is mentioned that LVADs have became a common choice for heart transplantation. It is concluded that use of cardiac imaging in continuous-flow LVADs helps in the determination of various changes in patients including ventricular function, size and intercardiac hemodynamics.

Aims: It is unknown whether there is an interaction between aspirin and angiotensin receptor blockers on outcomes in patients with heart failure (HF). [ABSTRACT FROM PUBLISHER]

Background: 2-D Echo is often performed in patients without history of coronary artery disease (CAD). We sought to determine echo features predictive of CAD. Methods: 2-D Echo of 328 patients without known CAD performed within one year prior to stress myocardial SPECT and angiography were reviewed. Echo features examined were left ventricular and atrial enlargement, LV hypertrophy, wall motion abnormality (WMA), LV ejection fraction (EF) < 50%, mitral annular calcification (MAC) and aortic sclerosis/stenosis (AS). High risk myocardial perfusion abnormality (MPA) was defined as >15% LV perfusion defect or multivessel distribution. Severe coronary artery stenosis (CAS) was defined as left main, 3 VD or 2VD involving proximal LAD. Results: The mean age was 62 ± 13 years, 59% men, 29% diabetic (DM) and 148 (45%) had > 2 risk factors. Pharmacologic stress was performed in 109 patients (33%). MPA was present in 200 pts (60%) of which, 137 were high risk. CAS was present in 166 pts (51%), 75 were severe. Of 87 patients with WMA, 83% had MPA and 78% had CAS. Multivariate analysis identified age >65, male, inability to exercise, DM, WMA, MAC and AS as independent predictors of MPA and CAS. Independent predictors of high risk MPA and severe CAS were age, DM, inability to exercise and WMA. 2-D echo findings offered incremental value over clinical information in predicting CAD by angiography. (Chi square: 360 vs. 320 p = 0.02). Conclusion: 2-D Echo was valuable in predicting presence of physiological and anatomical CAD in addition to clinical information. [ABSTRACT FROM AUTHOR]

The past decade has seen significant advances in dynamic imaging of the aorta. Today's vascular surgeons have the opportunity to choose from a wide array of imaging modalities to evaluate different aortic pathologies. While vascular ultrasound and aortography are considered to be the bread and butter imaging modalities, newer dynamic imaging techniques provide time-resolved information in various aortic pathologies. However, despite growing evidence of their advantages in the literature, they have not been routinely adopted. In order to understand the role of these emerging modalities, one must understand their principles, advantages, and limitations in the context of various clinical scenarios. In this review, we provide an overview of dynamic imaging techniques for aortic pathologies and describe various dynamic computed tomography and magnetic resonance imaging protocols, clinical applications, and potential future directions. [ABSTRACT FROM AUTHOR]

Of the 100,000-plus valve surgeries performed each year in the United States, up to 6% of those develop complications from prosthetic valve dysfunction. Prosthetic valve dysfunction (PVD) can be life threatening and often challenging to diagnose. In this review, we discuss the prevalence and incidence of PVD, explore its different etiologies, and assess the role of multimodality imaging with an emphasis on cardiac multidetector computed tomography (MDCT) for evaluating patients with PVD. We also investigate the utility of MDCT in preprocedural planning for transcatheter devices and redo surgical planning and discuss management strategies for patients with PVD. [ABSTRACT FROM AUTHOR]

Cardiac computed tomography angiography (CCTA) has evolved into a versatile imaging modality that can depict atherosclerosis burden, determine functional significance of a stenotic lesion, and guide the management and treatment of stable coronary artery disease.1 With newer-generation scanners, diagnostic CCTA can be obtained in the majority of patients with a very acceptable radiation dose. We discuss the ability of CCTA to provide comprehensive assessment of a patient with suspected CAD, including functional techniques of stress-rest myocardial perfusion assessment using a vasodilator and a purely post-processing approach that assesses fractional flow reserve derived by CCTA. In addition, recent data validated the role of CCTA in managing stable patients with chest pain and suspected CAD, serving as a gatekeeper for invasive coronary angiogram as well as optimizing the preprocedural planning of percutaneous coronary revascularization and coronary artery bypass surgery. [ABSTRACT FROM AUTHOR]

The article presents a case of an 81-year-old female who is experiencing fever and shortness of breath. She previously underwent aortic valve replacement and coronary artery bypass grafting. Based on blood cultures, she is positive for vancomycin-intermediate Staphylococcus aureus. She was eventually diagnosed with pseudoaneurysm formation in the mitral-aortic intervalvular fibrosa (MAIVF) and underwent debridement of aortic annulus and aortic root and ascending aorta replacement.

Objective: To correlate the left ventricular parameters obtained with 64-slice Volumetric Computed Tomography (VCT) with those obtained with the reference standard, cardiovascular magnetic resonance (CMR) imaging. Methods: VCT and a 3.0 T MRI scanner were used. Results from both studies were independently evaluated by two cardiologists. A linear correlation and a paired Student's t test were used to analyze the data with a P < 0.05 being considered significant. Results: Thirty consecutive patients were evaluated with VCT and CMR. The left ventricular indices for CMR and VCT were, respectively, mass 86.4 ± 25.8 vs. 82.7 ± 27.6 g (P = 0.31); ESV 45.5 ± 27.8 vs. 48.7 ± 40.4 ml (P = .405); EDV 101.3 ± 32.7 vs. 105.1 ± 44.0 ml (P = 0.475); SV 55.9 ± 16.1 vs. 56.8 ± 15.6 ml (P = 0.713); LVEF 57.5 ± 13.2% vs. 56.9 ± 12.4% (P = 0.630). No differences in intraobserver variability for both methods were found, CT r = 0.96, r² = 0.92 P < 0.0001 and MR r = 0.96 r² = 0.93 P < 0.0001. There was no significant statistical difference in the presence of artifacts. Conclusion: There is a close correlation between CMRI and VCT in the evaluation of LV function. VCT is as useful as 3 T CMR, and could be incorporated as another resource for evaluating LV function. [ABSTRACT FROM AUTHOR]

The article describes the case of a 61-year-old female patient who was diagnosed with aortic valve dysfunction caused by pannus. It notes that the patient was experiencing ventricular tachycardia and being examined through transthoracic echocardiogram and cardian multidetector computed tomography (MDCT). Information from the imaging tests confirmed that the patient's prosthetic aortic valve was not functioning due to an obstruction caused by a pannus or fibrovascular soft tissue.

The objective of this study was to examine the additive prognostic performance of coronary artery calcium score (CACS) over coronary computed tomography angiography (CCTA) stenosis assessment in symptomatic patients suspected for coronary artery disease (CAD) undergoing CCTA. A total of 805 symptomatic patients without known history of CAD who underwent coronary evaluation by multidetector cardiac CT were analyzed. Mean age of the cohort was 58 ± 13 years. A total of 44% (354 of 805) of the patients had a 0 CACS, 27% (215 of 805) had CACS 1 to 100, 14% (111 of 805) had CACS 101 to 400, and 15% (125 of 805) had CACS >400. CCTA showed normal coronary arteries in 43% (349 of 805) of patients, ≤50% stenosis in 42% (333 of 805), and >50% stenosis in 15% (123 of 805). Patients were followed for 2.3 ± 0.9 years. Major adverse cardiac event (MACE) was defined as cardiac death, nonfatal myocardial infarction, and late coronary revascularization. Overall incidence of MACE was 1.4% per year. Both CACS and CCTA stenosis were independently associated with increased MACE (p <0.05 for both). Addition of CACS into the model with clinical risk factors and CCTA stenosis significantly improved predictive performance for MACE from the model with clinical risk factors and CCTA stenosis only (global chi-square score 108 vs 70; p = 0.019). In conclusion; in symptomatic patients without known CAD, both CACS and CCTA stenosis were independently associated with increased cardiac events, and performing nonecontrast-enhanced CACS evaluation in addition to contrast-enhanced CCTA improved predictive ability for future cardiac events compared to CCTA stenosis assessment alone. [ABSTRACT FROM AUTHOR]

Background: Atherosclerotic coronary artery disease (CAD) has long been shown to involve chronic low-grade subclinical inflammation. However, whether there is association between hematological indices assessed by complete blood count (CBC) and coronary atherosclerotic burden has not been well studied. Materials and Methods: Consecutive 868 patients without known CAD who presented with acute chest pain to emergency department and underwent coronary artery calcium (CAC) scoring evaluation by multi-detector cardiac computed tomography were included in our study. Clinical characteristics and CBC indices were compared among different CAC groups. Results: The cohort comprised 60% male with a mean age of 61 (SD = 14) years. Median Framingham risk of CAD was 4% (range 1-16%). Median CAC score was 0 (IQR 0-43). Higher CAC groups had significantly higher Framingham risk of CAD than lower CAC groups (P < 0.001). Among different CAC categories, there was no statistically significant difference in hemoglobin level (p 0.45), mean corpuscular volume (p 0.43), mean corpuscular hemoglobin (p 0.28), mean corpuscular hemoglobin volume (p 0.36), red cell distribution width (0.42), total white blood cell counts (p 0.291), neutrophil counts (p 0.352), lymphocyte counts (p 0.92), neutrophil to lymphocyte ratio (p 0.68), monocyte count (p 0.48), and platelet counts (p 0.25). Conclusion: Our study did not detect significant association between hematological indices assessed with CBC and coronary calcification in symptomatic patients without known CAD. [ABSTRACT FROM AUTHOR]

For the past decade, multidetector cardiac computed tomography and its main application, coronary computed tomography angiography, have been established as a noninvasive technique for anatomical assessment of coronary arteries. This new era of coronary artery evaluation by coronary computed tomography angiography has arisen from the rapid advancement in computed tomography technology, which has led to massive diagnostic and prognostic clinical studies in various patient populations. This article gives a brief overview of current multidetector cardiac computed tomography systems, developing cardiac computed tomography technologies in both hardware and software fields, innovative radiation exposure reduction measures, multidetector cardiac computed tomography functional studies, and their newer clinical applications beyond coronary computed tomography angiography. [ABSTRACT FROM AUTHOR]

Obesity paradox has been described in various populations of coronary artery disease, mainly asymptomatic subjects. However, relationship between obesity and coronary artery calcification detected by cardiac CT in symptomatic patients has rarely been demonstrated. This study seeks to investigate whether the paradoxical relationship between obesity and coronary artery calcification exists in patients with acute chest pain. A final cohort of 1030 chest pain patients presenting at our emergency department who underwent coronary evaluation by multidetector cardiac CT were examined. With absent-to-mild coronary calcification (CAC score < 100) as a referent, multivariable analysis showed that presence of obesity (OR 0.564; 95% CI 0.395,0.806; P 0.002), body mass index (OR 0.945; 95% CI 0.920, 0.971; P < 0.001), body weight (OR 0.987; 95% CI 0.979, 0.995; P 0.001), and body surface area (OR 0.582; 95% CI 0.369, 0.920; P 0.020) were inversely associated with moderate-to-severe coronary calcification (CAC score > 100). This study extends the concept of obesity paradox to symptomatic patients undergoing coronary artery calcium score assessment. However, biological explanation(s) of this paradox remains unanswered. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 42 year old woman who is presented with stoke and history of fever and a large pseudoaneurysm of the intervalvular fibrosa is being displayed during multidetector cardiac computed tomography (MDCT).

Persistent left superior vena cava (PLSVC) is a very rare and yet the most commonly described thoracic venous anomaly in medical literature. It has a 10-fold higher incidence with congenital heart disease. PLSVC often becomes apparent when an unknown PLSVC is incidentally discovered during central venous line placement, intracardiac electrode/pacemaker placement or cardiopulmonary bypass, where it may cause technical difficulties and life-threatening complications. PLSVC is also associated with disturbances of cardiac impulse formation and conduction including varying degrees of heart blocks, supraventricular arrhythmias and Wolff Parkinson White syndrome. We describe the case of an 86-year-old male with a history of coronary artery disease and chronic atrial fibrillation who presented with worsening dyspnea and syncopal episodes. An ECG was consistent with complete heart block. During lead placement for the pacemaker, a left subclavian approach was unsuccessful. A left venogram was performed through the brachial vein that demonstrated a left superior vena cava. The diagnosis was confirmed with echocardiography using a bubble study and also a chest CT. The anatomy was unique as there was anomalous left hepatic vein drainage into the right atrium. The case provides insight into the diagnostic modalities and clinical considerations of this unusual thoracic venous anomaly. [ABSTRACT FROM AUTHOR]

Single coronary artery (SCA) is a very rare finding. Although most cases of SCA are found incidentally on coronary angiography, it can potentially lead to different clinical repercussions.1, 2 Herein we describe a patient with SCA who had unstable angina with subsequent sudden cardiac arrest, and we provide a brief review of the recent literature. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 77-year-old male with sick sinus syndrome status. The chest X-ray conducted to the patient showed abnormal course of the pacemaker suggestive of a lead in the left ventricle (LV) and the electrocardiogram (ECG) revealed right bundle branch block (RBBB) pattern of the pace beat. It discusses the malposition of a ventricular lean into the LV.

The article describes a case of giant pericardial cyst presenting as pneumonia in a 71-year-old woman presented with symptoms of dyspnea, cough and fever. Her chest radiography showed interstitial infiltrates confirming the diagnosis of pneumonia. Also identified was a low-density mass adjacent to the right side of the heart. Results of her cardiovascular magnetic resonance imaging are also described.

The article presents a case study of a 41-year-old female with bioprosthetic tricuspid valve who was hospitalized for dyspnea.

The article presents a case study of a 49-year-old man with hypertension and suffering epigastric abdominal pain. It states that the man was diagnosed to have type B aortic dissecting aneurysm and a scimitar vein using magnetic resonance angiography (MRA). It adds that scimitar syndrome diagnosis was carried out using computed tomography, cardiac catheterization, and MRA.

The article presents a case study of a 65-year-old man suffering from paroxysmal atrial fibrillation and hypertension. The patient was recommended for a radiofrequency catheter ablation (RFCA) of the pulmonary veins to avoid recurrent episodes. Furthermore, he underwent cardiac computed tomography (CT) and revealed an anomalous left circumflex artery which coexists with septal defect to the atrium.

Transient ischemic dilatation (TID) is a phenomenon that occurs when there is subendocardial ischemia and the post-stress tomograms show a larger left ventricular cavity size compared to the rest images. We present a rare case of reverse TID in which the opposite findings are seen. [ABSTRACT FROM AUTHOR]