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1. Cardiopoietic cell therapy for advanced ischemic heart failure : results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial

Author

Bartunek, Jozef, Terzic, Andre, Davison, Beth A, Filippatos, Gerasimos S, Radovanovic, Slavica, Beleslin, Branko, Merkely, Bela, Musialek, Piotr, Wojakowski, Wojciech, Andreka, Peter, Horvath, Ivan G, Katz, Amos, Dolatabadi, Dariouch, El Nakadi, Badih, Arandjelovic, Aleksandra, Edes, Istvan, Seferovic, Petar M, Obradovic, Slobodan, Vanderheyden, Marc, Jagic, Nikola, Petrov, Ivo, Atar, Shaul, Halabi, Majdi, Gelev, Valeri L, Shochat, Michael K, Kasprzak, Jaroslaw D, Sanz Ruiz, Ricardo, Heyndrickx, Guy R, Nyolczas, Noémi, Legrand, Victor, Guédès, Antoine, Heyse, Alex, Moccetti, Tiziano, Fernandez Aviles, Francisco, Jimenez Quevedo, Pilar, Bayes Genis, Antoni, Hernandez Garcia, Jose Maria, Ribichini, Flavio, Gruchala, Marcin, Waldman, Scott A, Teerlink, John R, Gersh, Bernard J, Povsic, Thomas J, Henry, Timothy D, Metra, Marco, Hajjar, Roger J, Tendera, Michal, Behfar, Atta, Alexandre, Bertrand, Seron, Aymeric, Stough, Wendy Gattis, Sherman, Warren, Cotter, Gad, Wijns, W. i. l. l. i. a. m. Collaborators Clinical investigators, Dens, sites Belgium: Ziekenhuis Oost Limburg: J., Dupont, M., Mullens, W., Janssens, M., Dolatabadi, Hoˆpital Civil de Charleroi: D., De Bruyne, Y., Lalmand, J., Dubois, P., El Nakadi, B., Aminian, A., De Vuyst, E., Gurnet, P., Gujic, M., Blankoff, I., Guedes, CHU Mont Godinne UCL: A., Gabriel, L., Seldrum, S., Doyen, C., Andre´, M., Heyse, AZ Glorieux: A., Van Durme, F., Verschuere, J., Legrand, Domaine Universitaire du Sart Tilman: V., Gach, O., D’Orio, V., Davin, L., Lancellotti, P., Baudoux, E., Ancion, A., Dulgheru, R., Vanderheyden, OLV Ziekenhuis Aalst – Cardiologie: M., Bartunek, J., Wijns, W., Verstreken, S., Penicka, . M., Gelev, P. Meeus Bulgaria: Tokuda Hospital Sofia: V., Zheleva Kichukova, I., Parapunova, R., Melamed, R., Sardovski, S., Radev, O., Yordanov, A., Radinov, A., Nenov, D., Amine, I., Petrov, City Hospital Clinic Cardiology Center: I., Kichukov, K., Nikitasov, L., Stankov, Z., Stoyanov, H., Tasheva Dimitrova, I., Angelova, M., Dimitrov, E., Minchev, M., Garvanski, I., Botev, C., Polomski, P., Alexandrovska University Hospital, Vassilev, Sofia: D., Karamfiloff, K., Tarnovska Kadreva, R., Vladimirova, L., Dimitrov, G., Hadzhiev, E., Tzvetkova, G., Andreka, . M. Atanasova Hungary: Gottsegen Gyo¨ rgy Orszagos Kardiologiai Inte´zet: P., Fontos, G., Fabian, J., Csepregi, A., Uzonyi, G., Gelei, A., Edes, Debreceni Egyetem Orvos e´s Ege´szse´gtudomanyi Centrum Altalanos Orvostudomanyi Kar Kardiologia Inte´zet: I., Balogh, L., Vajda, G., Darago, A., Gergely, S., Fulop, T., Jenei, C., Horvath, Pe´csi Tudomanyegyetem Klinikai Ko¨zpont Szıvgyogyaszati Klinika: I., Magyari, B., Nagy, A., Cziraki, A., Faludi, R., Kittka, B., Alizadeh, H., Merkely, Semmelweis Egyetem Varosmajori Szıv e´s Ergyogyaszati Klinika: B., Geller, L., Farkas, P., Szombath, G., Foldes, G., Skopal, J., Kovacs, A., Kosztin, A., Gara, E., Sydo, N., Nyolczas, MH Ege´szse´gu¨gyi Ko¨zpont Kardiologiai Osztaly: N., Kerecsen, G., Korda, A., Kiss, . M., Borsanyi, T., Polgar, B., Muk, B., Sharif, Z. Bari Ireland: HRB Clinical Research Facility: F., Atar, Y. M. Smyth Israel:Western Galilee Hospital: S., Shturman, A., Akria, L., Kilimnik, M., Brezins, M., Halabi, Ziv Medical Center: M., Dally, N., Goldberg, A., Aehab, K., Rosenfeld, I., Levinas, T., Saleem, D., Katz, Barzilai Medical Center: A., Plaev, T., Drogenikov, T., Nemetz, A., Barshay, Y., Jafari, J., Orlov, I., Nazareth Hospital EMMS: M. Omory, N. Kogan Nielsen, Shochat, Hillel Yaffe Medical Center: M., Shotan, A., Frimerman, A., Meisel, S., Asif, A., Sofer, O., Blondheim, D. S., Vazan, A., Metra, L. Arobov Italy: A. O. Spedali Civili di Brescia: M., Bonadei, I., Inama, L., Chiari, E., Lombardi, C., Magatelli, M., Russo, D., Lazzarini, V., Carubelli, V., Vassanelli, AOUI Verona – Borgo Trento Hospital: C., Ribichini, Flavio Luciano, Bergamini, C., Krampera, Mauro, Cicoria, M. A., Zanolla, L., Dalla Mura, D., Gambaro, A., Rossi, A., Pesarini Poland: Jagiellonian University Department of Cardiac, G., Musialek, Vascular Diseases at John Paul II Hospital in Krakow: P., Mazurek, A., Drabik, L., Ka˛dzielski, A., Walter, Z., Dzieciuch Rojek, M., Rubis, P., Plazak, . W., Tekieli, L., Podolec, J., Orczyk, W., Sutor, U., Zmudka, K., Olszowska, M., Podolec, P., Gruchala, Uniwersyteckie Centrum Kliniczne: M., Ciecwierz, D., Mielczarek, M., Burakowski, S., Chmielecki, M., Zielinska, M., Frankiewicz, A., Wdowczyk, J., Stopczynska, I., Bellwon, J., Mosakowska, K., Nadolna, R., Wroblewska, J., Rozmyslowska, M., Rynkiewicz, M., Marciniak, I., Raczak, G., Tarnawska, M., Taszner, M., Kasprzak, Bieganski Hospital: J., Plewka, M., Fiutowska, D., Rechcinski, T., Lipiec, P., Sobczak, M., Weijner Mik, P., Wraga, M., Krecki, R., Markiewicz, M., Haval Qawoq, D., Wojakowski, Gornosla˛skie Centrum Medyczne Sla˛skie j. Akademii Medycznej: W., Ciosek, J., Dworowy, S., Gaszewska Zurek, E., Ochala, A., Cybulski, W., Jadczyk, T., Wanha, W., Parma, Z., Kozlowski, M., Dzierzak, M., Markiewicz Serbia: Clinical Hospital Center Zvezdara, M., Arandjelovic, Cardiology Clinic: A., Sekularac, N., Boljevic, D., Bogdanovic, A., Zivkovic, S., Cvetinovic, N., Loncar, G., Clinical Centre of Serbia, Beleslin, Cardiology Clinic: B., Nedeljkovic, M., Trifunovic, D., Giga, V., Banovic, M., Nedeljkovic, I., Stepanovic, J., Vukcevic, V., Djordjevic Dikic, A., Dobric, M., Obrenovic Kircanski, B., Seferovic, Cardiology Clinic: P., Orlic, D., Tesic, M., Petrovic, O., Milinkovic, I., Simeunovic, D., Jagic, Clinical Center of Kragujevac: N., Tasic, M., Nikolic, D., Miloradovic, V., Djurdjevic, P., Sreckovic, M., Zornic, N., Clinical Hospital Center Bezanijska Kosa, Radovanovic, Cardiology Department: S., Saric, J., Hinic, S., Djokovic, A., Ðordevic, S., Bisenic, V., Markovic, O., Stamenkovic, S., Malenkovic, V., Tresnjak, J., Misic, G., Cotra, D., Tomovic, L., Vuckovic, V., Clinic of Emergency Internal Medicine, Obradovic, Military Medical Academy: S., Jovic, Z., Vukotic, S., Markovic, D., Djenic, N., Ristic Andjelkov, A., Bayes Genis, D. Ljubinka Spain: Hospital Universitario Germans Trias I. Pujol: A., Rodriguez Leor, O., Labata, C., Vallejo, N., Ferrer, E., Batlle, M., Fernandez Aviles, Hospital General Universitario Gregorio Mara~non: F., Sanz Ruiz, R., Casado, A., Loughlin, G., Zatarain, E., Anguita, J., Ferna ndez Santos, M. E., Pascual, C., Bermejo, J., Hernandez Garcia, Hospital Clinico Universitario Virgen de la Victoria: J. M., Jimenez Navarro, M., Dominguez, A., Carrasco, F., Mu~noz, A., Garcia Pinilla, J. M., Ruiz, J., Queipo de Llano, M. P., Hernandez, A., Fernandez, A., Jimenez Quevedo, Hospital Clinico San Carlos: P., Guerra, R., Biagioni, C., Gonzalez, R. A., Gomez deDiego, J. J., Mansson Broberg, L. Perez de Isla Sweden: Karolinska University Hospital: A., Sylve´n, C., Leblanc, K., Winter, R., Blomberg, P., Gunyeli, E., Ruck, A., Silva, C., Fo¨rstedt Switzerland: CardioCentro Ticino, J., Moccetti, Switzerland: T., Rossi, M., Pasotti, E., Petrova, I., Crljenica, C., Monti, C., Murzilli, R., Su¨rder, D., Moccetti, M., Turchetto, L., Locicero, V., Chiumiento, L., Maspoli, S., Mombelli, M., Anesini, A., Biggiogero, M., Ponti, G., Camporini, C., Polledri, S., Hill, G. Dolci United Kingdom: Kings College Hospital: J., Plymen, C., Amin Youssef, G., Mcdonagh, T., Drasar, E., Mijovic, A., Jouhra, F., Mcloman, D., Dworakowski, R., Webb, I., Byrne, J., and Potter, V.

Subjects
0301 basic medicine, Male, Cardiopoiesis, Cardiovascular disease, Disease severity, Marker, Precision medicine, Regenerative medicine, Stem cell, Target population, Adult, Aged, Double-Blind Method, Female, Heart Failure, Humans, Mesenchymal Stem Cell Transplantation, Middle Aged, Myocardial Ischemia, Prospective Studies, Treatment Outcome, Young Adult, Cardiology and Cardiovascular Medicine, Cell- and Tissue-Based Therapy, mesenchymal stem-cells, 030204 cardiovascular system & hematology, Cardiorespiratory Medicine and Haematology, outcomes, Fast-Track Clinical Research, Sudden cardiac death, 0302 clinical medicine, Ischemia, cardiovascular disease, Clinical endpoint, target population, CHART Program, Ejection fraction, bone-marrow, Heart Failure/Cardiomyopathy, 3. Good health, Cohort, Cardiology, Fast Track, disease severity, delivery, medicine.medical_specialty, precision medicine, Clinical Sciences, regenerative medicine, 03 medical and health sciences, cardiopoiesis, Internal medicine, medicine, Adverse effect, marker, disease, business.industry, medicine.disease, mortality, Confidence interval, Clinical trial, stem cell, Editor's Choice, 030104 developmental biology, predictors, Cardiovascular System & Hematology, Heart failure, business
Abstract

Altres ajuts: This work was supported by Celyad, SA (Mont-Saint-Guibert, Belgium). Celyad has received research grants from the Walloon Region (Belgium, DG06 funding). Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort. This multinational, randomized, double-blind, sham-controlled study was conducted in 39 hospitals. Patients with symptomatic ischaemic heart failure on guideline-directed therapy (n = 484) were screened; n = 348 underwent bone marrow harvest and mesenchymal stem cell expansion. Those achieving > 24 million mesenchymal stem cells (n = 315) were randomized to cardiopoietic cells delivered endomyocardially with a retention-enhanced catheter (n = 157) or sham procedure (n = 158). Procedures were performed as randomized in 271 patients (n = 120 cardiopoietic cells, n = 151 sham). The primary efficacy endpoint was a Finkelstein–Schoenfeld hierarchical composite (all-cause mortality, worsening heart failure, Minnesota Living with Heart Failure Questionnaire score, 6-min walk distance, left ventricular end-systolic volume, and ejection fraction) at 39 weeks. The primary outcome was neutral (Mann–Whitney estimator 0.54, 95% confidence interval [CI] 0.47–0.61 [value > 0.5 favours cell treatment], P = 0.27). Exploratory analyses suggested a benefit of cell treatment on the primary composite in patients with baseline left ventricular end-diastolic volume 200–370 mL (60% of patients) (Mann–Whitney estimator 0.61, 95% CI 0.52–0.70, P = 0.015). No difference was observed in serious adverse events. One (0.9%) cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted or sudden cardiac death. The primary endpoint was neutral, with safety demonstrated across the cohort. Further evaluation of cardiopoietic cell therapy in patients with elevated end-diastolic volume is warranted.

Published
2017

2. Plaque quantification by coronary computed tomography angiography using intravascular ultrasound as a reference standard: a comparison between standard and last generation computed tomography scanners

Author

Gianluca Pontone, Marco Guglielmo, Andrea Annoni, Cesare Fiorentini, Giuseppe Muscogiuri, Piero Montorsi, Edoardo Conte, Paolo Ravagnani, Jeroen Sonck, Saima Mushtaq, Andrea Baggiano, Maria Elisabetta Mancini, Luca Di Odoardo, Mauro Pepi, Stefano Galli, Antonio L. Bartorelli, Carlotta Poggi, Daniele Andreini, Daniela Trabattoni, Alberto Formenti, Carlos Collet, Flavia Nicoli, Letizia Li Piani, Marco Magatelli, Graduate School, ACS - Heart failure & arrhythmias, Conte, E, Mushtaq, S, Pontone, G, Li Piani, L, Ravagnani, P, Galli, S, Collet, C, Sonck, J, Di Odoardo, L, Guglielmo, M, Baggiano, A, Trabattoni, D, Annoni, A, Mancini, M, Formenti, A, Muscogiuri, G, Magatelli, M, Nicoli, F, Poggi, C, Fiorentini, C, Bartorelli, A, Pepi, M, Montorsi, P, and Andreini, D

Subjects
Computed Tomography Angiography, whole-heart coverage CT, Computed tomography, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, intravascular ultrasound, 03 medical and health sciences, atherosclerosi, 0302 clinical medicine, Coronary plaque, Plaque volume, Intravascular ultrasound, medicine, Humans, Radiology, Nuclear Medicine and imaging, coronary plaque analysi, Reference standards, Ultrasonography, Interventional, medicine.diagnostic_test, business.industry, Radiation dose, Coronary computed tomography angiography, General Medicine, Reference Standards, coronary plaque volume, Plaque, Atherosclerotic, Heart Rhythm, coronary computed tomography angiography, atherosclerosis, Cardiology and Cardiovascular Medicine, Nuclear medicine, business, Tomography, X-Ray Computed, coronary plaque analysis
Abstract

Aims: The emerging role of coronary computed tomography angiography (CCTA) as a non-invasive tool for atherosclerosis evaluation is supported by data reporting a good correlation between CCTA and intravascular ultrasound (IVUS) for plaque volume quantification. Aim of the present study was to evaluate whether a last generation CT-scanner may improve coronary plaque volume assessment using IVUS as standard-of-reference. Methods and results: From a registry of 1915 consecutive, all-comers, patients who underwent a clinically indicated IVUS evaluation we enrolled 59 patients who underwent CCTA with a 64-slice CT (Group 1) and 59 patients who underwent CCTA with whole-heart coverage CT scanner (Group 2). Patients who underwent CCTA with unfavourable heart rhythm were not excluded from the analysis. Image quality (4-point Likert scale) focused on plaque analysis was evaluated. Plaque volume quantification by CCTA was compared to IVUS. No difference in clinical characteristics was found between Group 1 and Group 2. Plaque volume quantification by CCTA was considered not feasible in 11 plaques of Group 1 and in 4 plaques of Group 2 (P = 0.09). Higher correlation for plaque volume quantification by CCTA vs. IVUS was demonstrated in Group 2 when compared with Group 1 (r = 0.9888 vs. 0.9499; P < 0.0001). The Bland-Altman analysis showed plaque volume overestimation by CCTA of 11.9 mm3 in Group 1 and 4 mm2 in Group 2 (P < 0.001). Effective radiation dose of CCTA was significantly lower in Group 2 vs. Group 1 (2.7 ± 0.9 vs. 8.1 ± 3.6 mSv, respectively; P < 0.001). Conclusions: CCTA using a new scanner generation showed to be an accurate non-invasive tool to assess and quantify coronary plaque volume.

Published
2020

3. CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression

Author

Luca Di Odoardo, Maria Elisabetta Mancini, Piero Montorsi, Daniela Trabattoni, Andrea Annoni, Jeroen Sonck, Giuseppe Muscogiuri, Giuseppe Calligaris, Marco Guglielmo, Daniele Andreini, Antonio L. Bartorelli, Andrea Baggiano, Elisa Consiglio, Alberto Formenti, Mauro Pepi, Stefano De Martini, Edoardo Conte, Paolo Ravagnani, Saima Mushtaq, Cesare Fiorentini, Gianluca Pontone, Federico Lombardi, Franco Fabbiocchi, Giovanni Teruzzi, Paolo Olivares, Marco Magatelli, Andrea D'Errico, Carlos Collet, Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Collet, C, Sonck, J, D'Errico, A, Di Odoardo, L, Guglielmo, M, Baggiano, A, Trabattoni, D, Ravagnani, P, Montorsi, P, Teruzzi, G, Olivares, P, Fabbiocchi, F, De Martini, S, Calligaris, G, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Consiglio, E, Muscogiuri, G, Lombardi, F, Fiorentini, C, Bartorelli, A, Pepi, M, Clinical sciences, Graduate School, and ACS - Heart failure & arrhythmias

Subjects
Male, Adenosine, Computed Tomography Angiography, Vasodilator Agents, viruses, medicine.medical_treatment, invasive coronary angiography, Perfusion scanning, Coronary Artery Disease, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, 030218 nuclear medicine & medical imaging, Coronary artery disease, coronary stent, 0302 clinical medicine, Restenosis, heterocyclic compounds, Prospective Studies, musculoskeletal, neural, and ocular physiology, Myocardial Perfusion Imaging, Middle Aged, static CT perfusion, Fractional Flow Reserve, Myocardial, Treatment Outcome, Disease Progression, Female, Stents, Radiology, Cardiology and Cardiovascular Medicine, Perfusion, medicine.drug, medicine.medical_specialty, coronary CT angiography, Article, Coronary Restenosis, 03 medical and health sciences, Percutaneous Coronary Intervention, Predictive Value of Tests, coronary stents, Multidetector Computed Tomography, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Aged, business.industry, Stent, Gold standard (test), medicine.disease, Iodixanol, enzymes and coenzymes (carbohydrates), business
Abstract

Objectives: The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard. Background: Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation. Methods: Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses. Results: In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv. Conclusions: In patients with coronary stents, CTP significantly improved the diagnostic rate and accuracy of coronary CTA alone compared with both ICA and invasive FFR as gold standard.

Published
2020

4. Low-Dose Coronary CT Angiography in Patients with Atrial Fibrillation: Comparison of Image Quality and Radiation Exposure with Two Different Approaches

Author

Andrea Annoni, Marco Guglielmo, Giuseppe Muscogiuri, Luca Di Odoardo, Alberto Formenti, Eleonora Melotti, Daniele Andreini, Edoardo Conte, Saima Mushtaq, Antonio L. Bartorelli, Andrea Baggiano, Maria Elisabetta Mancini, Cesare Fiorentini, Elisa Consiglio, Gianluca Pontone, Margarida Oliveira, Mauro Pepi, Marco Magatelli, Mushtaq, S, Pontone, G, Conte, E, Guglielmo, M, Consiglio, E, Magatelli, M, Oliveira, M, Muscogiuri, G, Annoni, A, Baggiano, A, Formenti, A, Mancini, M, Di Odoardo, L, Melotti, E, Fiorentini, C, Bartorelli, A, Pepi, M, and Andreini, D

Subjects
Male, medicine.medical_specialty, Scanner, Image quality, Computed Tomography Angiography, Coronary Disease, Iterative reconstruction, Coronary Angiography, Radiation Dosage, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Coronary CT angiography, Image resolution, Interpretability, Aged, business.industry, Radiation exposure, Atrial fibrillation, Coronary ct angiography, Middle Aged, medicine.disease, Image Enhancement, 030220 oncology & carcinogenesis, Female, Radiology, business
Abstract

Rationale and Objectives: To evaluate image quality, coronary interpretability and radiation exposure of coronary CT angiography (CCTA)performed in patients with atrial fibrillation (AF)with the latest scanner generation, comparing two different technical approaches. A new scanner that combines a 0.23 mm spatial resolution, a new generation of iterative reconstruction, fast gantry rotation time and the intracycle motion-correction algorithm to improve the temporal resolution was recently introduced in the clinical field. Materials and Methods: We enrolled 105 consecutive patients with chronic AF who performed CCTA with a whole-heart coverage high-definition CT scanner (16-cm z-axis coverage with 256 detector rows, 0.28 s gantry rotation time). Five of them were excluded for impaired renal function. Patients were randomized between a double acquisition protocol (50 patients, group 1)or a single acquisition protocol (50 patients, group 2). The image quality, coronary segment interpretability and effective dose (ED)of CCTA were assessed. Results: The mean HR during the scan was 85.6±21 bpm in group 1 vs. 83.7±23 bpm in Group 2, respectively (p < ns). In group 2, overall image quality was high and comparable with that of group 1 (Likert scale =3.2 ± 1.4 vs. 3.3 ± 1.2, p = ns, in group 1 and 2, respectively). Coronary interpretability was high and similar between the two groups (97.5% and 97.1% in group 1 and 2, p = ns, respectively). Mean ED was significantly higher in group 1 than in group 2 (5.3 ± 1.8 mSv vs. 2.7 ± 0.7 mSv, p < 0.001). Conclusion: The novel whole-heart coverage CT scanner allows to perform CCTA with a single-acquisition protocol with high image quality and low radiation exposure in AF patients.

Published
2019

5. Diagnostic accuracy of coronary CT angiography performed in 100 consecutive patients with coronary stents using a whole-organ high-definition CT scanner

Author

Cesare Fiorentini, Marco Guglielmo, Gianluca Pontone, Daniele Andreini, Luca Di Odoardo, Maria Elisabetta Mancini, Edoardo Conte, Saima Mushtaq, Andrea Baggiano, Mauro Pepi, Eleonora Melotti, Andrea Annoni, Giuseppe Muscogiuri, Piero Montorsi, Antonio L. Bartorelli, Alberto Formenti, Marta L. Resta, Marco Magatelli, Andreini, D, Pontone, G, Mushtaq, S, Conte, E, Guglielmo, M, Mancini, M, Annoni, A, Baggiano, A, Formenti, A, Montorsi, P, Magatelli, M, Di Odoardo, L, Melotti, E, Resta, M, Muscogiuri, G, Fiorentini, C, Bartorelli, A, and Pepi, M

Subjects
Male, medicine.medical_specialty, Image quality, Computed Tomography Angiography, medicine.medical_treatment, Reproducibility of Result, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Follow-Up Studie, 03 medical and health sciences, 0302 clinical medicine, Restenosis, Coronary Restenosi, Heart Rate, Positive predicative value, Coronary stent, medicine, Stent, 030212 general & internal medicine, Prospective cohort study, Coronary Vessel, Interpretability, Aged, business.industry, Atrial fibrillation, Middle Aged, medicine.disease, Algorithm, Prospective Studie, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Aims To evaluate image quality, interpretability, diagnostic accuracy and radiation exposure of coronary CT angiography (CCTA) performed with a new scanner equipped with 0.23-mm spatial resolution, new generation iterative reconstruction, 0.28-second gantry rotation time and intra-cycle motion-correction algorithm in consecutive patients with coronary stents, including those with high heart rate (HR) and atrial fibrillation (AF). Materials and methods We enrolled 100 consecutive patients (85 males, mean age 65 ± 10 years) with previous coronary stent implantation scheduled for clinically indicated non-emergent invasive coronary angiography (ICA). Image quality, coronary interpretability and diagnostic accuracy vs. ICA were evaluated and the effective dose (ED) was recorded. Results Mean HR during the scan was 67 ± 13 bpm. Twenty-six patients had >65 bpm HR during scanning and 13 patients had AF. Overall, image quality was high (Likert = 3.2 ± 0.9). Stent interpretability was 95.8% (184/192 stents). Among 192 stented segments, CCTA correctly identified 22 out of 24 with >50% in-stent restenosis (ISR) (sensitivity 92%). In a stent-based analysis, specificity, positive and negative predictive values and diagnostic accuracy for ISR detection were 91%, 99%, 60% and 91%, respectively. In a patient-based analysis, CCTA diagnostic accuracy was 85%. Overall, mean ED of CCTA was 2.4 ± 1.2 mSv. Conclusions A whole-organ CT scanner was able to evaluate coronary stents with good diagnostic performance and low radiation exposure, also in presence of unfavorable HR and heart rhythm. Translational aspect The present study is the first to evaluate the CCTA capability of detecting in-stent restenosis in consecutive patients, including those with high HR and AF, using a recent scanner generation that combines improved spatial and temporal resolution with wide coverage. Using the whole-organ high-definition CT scanner we obtained high quality images of coronary stents with good interpretability and diagnostic accuracy combined with low radiation exposure, even in patients with unfavorable HR or heart rhythm for CCTA evaluation.

Published
2019

6. Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study

Author

Piero Montorsi, Antonio L. Bartorelli, Elisa Consiglio, Andrea Baggiano, Stefano Galli, Franco Fabbiocchi, Marco Guglielmo, Daniela Trabattoni, Alberto Formenti, Gianluca Pontone, Cesare Fiorentini, Mauro Pepi, Giuseppe Muscogiuri, Maria Elisabetta Mancini, Marco Magatelli, Jeroen Sonck, Andrea Annoni, Edoardo Conte, Saima Mushtaq, Carlos Collet, Daniele Andreini, Cristina Ferrari, Stefano De Martini, Marta L. Resta, Graduate School, ACS - Heart failure & arrhythmias, Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Sonck, J, Collet, C, Guglielmo, M, Baggiano, A, Trabattoni, D, Galli, S, Montorsi, P, Ferrari, C, Fabbiocchi, F, De Martini, S, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Resta, M, Consiglio, E, Muscogiuri, G, Fiorentini, C, Bartorelli, A, Pepi, M, and Cardiology

Subjects
ED, effective dose, Computed Tomography Angiography, CAD, coronary artery disease, medicine.medical_treatment, viruses, Predictive Value of Test, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, 030218 nuclear medicine & medical imaging, Coronary artery disease, 0302 clinical medicine, Clinical Protocols, Restenosis, Coronary Restenosi, Stent, heterocyclic compounds, Prospective Studies, Computed tomography angiography, medicine.diagnostic_test, Myocardial Perfusion Imaging, CCTA, coronary computed tomography angiography, CTP, computed tomography perfusion, Fractional Flow Reserve, Myocardial, Research Design, Stents, Radiology, Cardiology and Cardiovascular Medicine, Human, FFR, fractional flow reserve, medicine.medical_specialty, Reproducibility of Result, Coronary Restenosis, 03 medical and health sciences, Myocardial perfusion imaging, Percutaneous Coronary Intervention, Predictive Value of Tests, Multidetector Computed Tomography, Coronary stent, medicine, Humans, Radiology, Nuclear Medicine and imaging, Clinical Protocol, business.industry, Reproducibility of Results, Percutaneous coronary intervention, medicine.disease, Prospective Studie, enzymes and coenzymes (carbohydrates), business
Abstract

Background Recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR). However, coronary stent assessment is still challenging, especially because of beam-hardening artifacts due to metallic stent struts and high atherosclerotic burden of non-stented segments. Adenosine-stress myocardial perfusion assessed by CT (CTP) recently demonstrated to be a feasible and accurate tool for evaluating the functional significance of coronary stenoses in patients with suspected coronary artery disease (CAD). Yet, scarce data are available on the performance of CTP in patients with previous stent implantation. Aim of the study We aim to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with a new scanner generation using quantitative invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as standard of reference. Methods We will enroll 300 consecutive patients with previous stent implantation, referred for non-emergent and clinically indicated invasive coronary angiography (ICA) due to suspected ISR or progression of CAD in native coronary segments. All patients will be subjected to stress myocardial CTP and a rest CCTA. The first 150 subjects will undergo static CTP scan, while the following 150 patients will undergo dynamic CTP scan. Measurement of invasive FFR will be performed during ICA when clinically indicated. Results The primary study end points will be: 1) assessment of the diagnostic performance (diagnostic rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. ICA as standard of reference in a territory-based and patient-based analysis; 2) assessment of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. invasive FFR as standard of reference in a territory-based analysis. Conclusions The ADVANTAGE study aims to provide an answer to the intriguing question whether the combined anatomical and functional assessment with CCTA plus CTP may have higher diagnostic performance as compared to CCTA alone in identifying stented patients with significant ISR or CAD progression.

Published
2018

7. Plaque assessment by coronary CT angiography may predict cardiac events in high risk and very high risk diabetic patients: A long-term follow-up study.

Author

Andreini D, Conte E, Mushtaq S, Magatelli M, Traversari F, Gigante C, Belmonte M, Gaudenzi-Asinelli M, Annoni A, Formenti A, Mancini ME, Guglielmo M, Baggiano A, Melotti E, Muscogiuri G, Rondinelli M, Pontone G, Bartorelli AL, Pepi M, and Genovese S

Subjects
Computed Tomography Angiography, Coronary Angiography methods, Follow-Up Studies, Humans, Predictive Value of Tests, Prognosis, Risk Assessment, Risk Factors, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Diabetes Mellitus diagnosis, Plaque, Atherosclerotic diagnostic imaging, Plaque, Atherosclerotic therapy
Abstract

Background and Aims: The aim of the present study is to evaluate whether advanced coronary atherosclerosis analysis by CCTA may improve prognostic stratification among diabetic patients at high cardiovascular risk (CV risk)., Methods and Results: The study population consisted of 265 consecutive diabetic patients at high CV risk who underwent CCTA for suspected CAD between January 2011 and December 2016. For every patients both traditional and advanced, qualitative and quantitative coronary plaque analysis were performed. The occurrence of cardiac death, ACS, and non-urgent revascularization were recorded at follow-up. Among the 265 patients enrolled, 21 were lost to follow-up, whereas 244 (92%) had a complete follow-up (mean 45 ± 22 months) and were classified at high (n = 67) or very high cardiovascular risk (n = 177), according to ESC Guidelines. A total of 63 events were recorded (3 Cardiac Death, 3 NSTEMI, 8 unstable angina, 36 late non-urgent revascularization and 13 non-cardiac death) in 57 different patients. Elevated fibro-fatty plaque volume was the only predictor of events over age, gender and traditional risk factor when ACS and MACE were considered as end-points [HR (95% CI) 6.01 (1.65-21.87), p = 0.006 and 3.46 (2.00-5.97); p < 0.001]., Conclusion: The present study confirms the prognostic role of advance coronary atherosclerosis evaluation beyond risk factors and stenosis severity, even in diabetics. Despite the very high cardiovascular risk of study population, a not negligible portion (23%) of patients exhibited totally normal coronaries., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Published
2022
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8. Interpretability of coronary CT angiography performed with a novel whole-heart coverage high-definition CT scanner in 300 consecutive patients with coronary artery bypass grafts.

Author

Mushtaq S, Conte E, Pontone G, Pompilio G, Guglielmo M, Annoni A, Baggiano A, Formenti A, Mancini ME, Muscogiuri G, Nicoli F, Giannitto C, Magatelli M, Tanzilli A, Consiglio E, Fiorentini C, Bartorelli AL, Pirillo SP, Pepi M, and Andreini D

Subjects
Aged, Coronary Vessels diagnostic imaging, Equipment Design, Female, Heart Rate, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Radiation Dosage, Radiation Exposure, Reproducibility of Results, Treatment Outcome, Computed Tomography Angiography instrumentation, Coronary Angiography instrumentation, Coronary Artery Bypass adverse effects, Coronary Vessels surgery, Multidetector Computed Tomography instrumentation, Tomography Scanners, X-Ray Computed
Abstract

Aims: Coronary CT angiography (CCTA) is an accurate non-invasive tool for the evaluation of coronary artery bypass graft (CABG). However, inability to sustain a long breath-hold, high heart rate (HR) and atrial fibrillation may affect image quality. Moreover, radiation exposure is still a matter of some concern. A scanner combining 0.23-mm spatial resolution, new iterative reconstruction and fast gantry rotation time has been recently introduced in the clinical field. The aims of our study were to evaluate interpretability, radiation exposure and diagnostic accuracy of CCTA performed with the latest generation of cardiac-CT scanners compared to invasive coronary angiography (ICA) in the assessment of bypass grafts, and non-grafted and post-anastomotic native coronary arteries., Methods and Results: We prospectively enrolled 300 patients undergoing clinically indicated CCTA with a 16-cm z-axis coverage, 256-detector rows, and 0.28-sec gantry rotation time scanner. Coronary artery and graft interpretability, image quality and effective dose (ED) were assessed in all patients and diagnostic accuracy was evaluated in a subgroup of 100 patients who underwent ICA. Mean HR during the scan was 69.6 ± 10.8. Sinus rhythm was present in 118 patients with HR < 75 bpm and in 112 patients with HR ≥ 75 bpm, while 70 patients had atrial fibrillation. CABG interpretability was 100%. Compared to ICA, CCTA was able to correctly detecting occlusions or significant stenoses of all CABG segments. Overall interpretability of native coronary segments was 95.6%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of coronary arteries were 98.3%, 97.4%, 93.1%, 99.3% and 96.5%, respectively. The diagnostic accuracy in a patient based analysis was 95.2%. Mean ED was 3.14 ± 1.7 mSv., Conclusions: The novel whole-heart coverage CT scanner allows to evaluating CABG and native coronary arteries with excellent interpretability and low radiation exposure even in the presence of unfavorable heart rhythm., (Copyright © 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Published
2020
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9. CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression.

Author

Andreini D, Mushtaq S, Pontone G, Conte E, Collet C, Sonck J, D'Errico A, Di Odoardo L, Guglielmo M, Baggiano A, Trabattoni D, Ravagnani P, Montorsi P, Teruzzi G, Olivares P, Fabbiocchi F, De Martini S, Calligaris G, Annoni A, Mancini ME, Formenti A, Magatelli M, Consiglio E, Muscogiuri G, Lombardi F, Fiorentini C, Bartorelli AL, and Pepi M

Subjects
Adenosine administration & dosage, Aged, Coronary Artery Disease physiopathology, Coronary Restenosis physiopathology, Disease Progression, Female, Fractional Flow Reserve, Myocardial, Humans, Male, Middle Aged, Percutaneous Coronary Intervention adverse effects, Predictive Value of Tests, Prospective Studies, Treatment Outcome, Vasodilator Agents administration & dosage, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Coronary Restenosis diagnostic imaging, Multidetector Computed Tomography, Myocardial Perfusion Imaging, Percutaneous Coronary Intervention instrumentation, Stents
Abstract

Objectives: The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard., Background: Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation., Methods: Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses., Results: In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv., Conclusions: In patients with coronary stents, CTP significantly improved the diagnostic rate and accuracy of coronary CTA alone compared with both ICA and invasive FFR as gold standard., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2020
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10. Plaque quantification by coronary computed tomography angiography using intravascular ultrasound as a reference standard: a comparison between standard and last generation computed tomography scanners.

Author

Conte E, Mushtaq S, Pontone G, Li Piani L, Ravagnani P, Galli S, Collet C, Sonck J, Di Odoardo L, Guglielmo M, Baggiano A, Trabattoni D, Annoni A, Mancini ME, Formenti A, Muscogiuri G, Magatelli M, Nicoli F, Poggi C, Fiorentini C, Bartorelli AL, Pepi M, Montorsi P, and Andreini D

Subjects
Computed Tomography Angiography, Coronary Angiography, Humans, Reference Standards, Tomography, X-Ray Computed, Ultrasonography, Interventional, Coronary Artery Disease diagnostic imaging, Plaque, Atherosclerotic diagnostic imaging
Abstract

Aims: The emerging role of coronary computed tomography angiography (CCTA) as a non-invasive tool for atherosclerosis evaluation is supported by data reporting a good correlation between CCTA and intravascular ultrasound (IVUS) for plaque volume quantification. Aim of the present study was to evaluate whether a last generation CT-scanner may improve coronary plaque volume assessment using IVUS as standard-of-reference., Methods and Results: From a registry of 1915 consecutive, all-comers, patients who underwent a clinically indicated IVUS evaluation we enrolled 59 patients who underwent CCTA with a 64-slice CT (Group 1) and 59 patients who underwent CCTA with whole-heart coverage CT scanner (Group 2). Patients who underwent CCTA with unfavourable heart rhythm were not excluded from the analysis. Image quality (4-point Likert scale) focused on plaque analysis was evaluated. Plaque volume quantification by CCTA was compared to IVUS. No difference in clinical characteristics was found between Group 1 and Group 2. Plaque volume quantification by CCTA was considered not feasible in 11 plaques of Group 1 and in 4 plaques of Group 2 (P = 0.09). Higher correlation for plaque volume quantification by CCTA vs. IVUS was demonstrated in Group 2 when compared with Group 1 (r = 0.9888 vs. 0.9499; P < 0.0001). The Bland-Altman analysis showed plaque volume overestimation by CCTA of 11.9 mm3 in Group 1 and 4 mm2 in Group 2 (P < 0.001). Effective radiation dose of CCTA was significantly lower in Group 2 vs. Group 1 (2.7 ± 0.9 vs. 8.1 ± 3.6 mSv, respectively; P < 0.001)., Conclusions: CCTA using a new scanner generation showed to be an accurate non-invasive tool to assess and quantify coronary plaque volume., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Published
2020
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11. CMR for Identifying the Substrate of Ventricular Arrhythmia in Patients With Normal Echocardiography.

Author

Andreini D, Dello Russo A, Pontone G, Mushtaq S, Conte E, Perchinunno M, Guglielmo M, Coutinho Santos A, Magatelli M, Baggiano A, Zanchi S, Melotti E, Fusini L, Gripari P, Casella M, Carbucicchio C, Riva S, Fassini G, Li Piani L, Fiorentini C, Bartorelli AL, Tondo C, and Pepi M

Subjects
Adult, Female, Heart Diseases complications, Heart Diseases physiopathology, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Risk Assessment, Risk Factors, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular physiopathology, Ventricular Premature Complexes diagnosis, Ventricular Premature Complexes physiopathology, Echocardiography, Heart Diseases diagnostic imaging, Heart Rate, Magnetic Resonance Imaging, Cine, Tachycardia, Ventricular etiology, Ventricular Premature Complexes etiology
Abstract

Objectives: This study sought to determine whether cardiac magnetic resonance (CMR) may identify structural heart disease (SHD) in patients with ventricular arrhythmia who had echocardiography ruled out pathological findings., Background: Approximately one-half of sudden cardiac deaths are attributable to malignant VA. Echocardiography is commonly used to identify SHD that is the most frequent substrate of VA., Methods: A single-center prospective study was conducted in consecutive patients with significant VA, categorized as >1,000 but <10,000 ventricular ectopic beats [VEBs]/24 h; ≥10,000 VEBs/24 h; nonsustained ventricular tachycardia, sustained ventricular tachycardia, or a history of resuscitated cardiac arrest, and no pathological findings at echocardiography, requiring a clinically indicated CMR. Primary endpoint was CMR detection of SHD. Secondary endpoints were a composite of CMR detection of SHD and abnormal findings not specific for a definite SHD diagnosis., Results: A total of 946 patients were enrolled (mean 41 ± 16 years of age; 64% men). CMR studies were used to diagnose SHD in 241 patients (25.5%) and abnormal findings not specific for a definite SHD diagnosis in 187 patients (19.7%). Myocarditis (n = 91) was the more frequent disease, followed by arrhythmogenic cardiomyopathy (n = 55), dilated cardiomyopathy (n = 39), ischemic heart disease (n = 22), hypertrophic cardiomyopathy (n = 13), congenital cardiac disease (n = 10), left ventricle noncompaction (n = 5), and pericarditis (n = 5). The strongest univariate and multivariate predictors of SHD on CMR images were chest pain (odds ratios [OR]: 2.52 and 2.38, respectively) and sustained ventricular tachycardia (ORs: 2.67 and 2.23, respectively)., Conclusions: SHD was able to be identified on CMR imaging in a sizable number of patients with significant VA and completely normal echocardiography. Chest pain and sustained ventricular tachycardia were the strongest predictors of positive CMR imaging results., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2020
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12. Low-Dose Coronary CT Angiography in Patients with Atrial Fibrillation: Comparison of Image Quality and Radiation Exposure with Two Different Approaches.

Author

Mushtaq S, Pontone G, Conte E, Guglielmo M, Consiglio E, Magatelli M, Oliveira M, Muscogiuri G, Annoni A, Baggiano A, Formenti A, Mancini ME, Di Odoardo L, Melotti E, Fiorentini C, Bartorelli AL, Pepi M, and Andreini D

Subjects
Aged, Female, Humans, Male, Middle Aged, Prospective Studies, Radiation Dosage, Atrial Fibrillation complications, Computed Tomography Angiography methods, Coronary Angiography methods, Coronary Disease complications, Coronary Disease diagnosis, Image Enhancement methods, Radiation Exposure prevention & control
Abstract

Rationale and Objectives: To evaluate image quality, coronary interpretability and radiation exposure of coronary CT angiography (CCTA) performed in patients with atrial fibrillation (AF) with the latest scanner generation, comparing two different technical approaches. A new scanner that combines a 0.23 mm spatial resolution, a new generation of iterative reconstruction, fast gantry rotation time and the intracycle motion-correction algorithm to improve the temporal resolution was recently introduced in the clinical field., Materials and Methods: We enrolled 105 consecutive patients with chronic AF who performed CCTA with a whole-heart coverage high-definition CT scanner (16-cm z-axis coverage with 256 detector rows, 0.28 s gantry rotation time). Five of them were excluded for impaired renal function. Patients were randomized between a double acquisition protocol (50 patients, group 1) or a single acquisition protocol (50 patients, group 2). The image quality, coronary segment interpretability and effective dose (ED) of CCTA were assessed., Results: The mean HR during the scan was 85.6±21 bpm in group 1 vs. 83.7±23 bpm in Group 2, respectively (p < ns). In group 2, overall image quality was high and comparable with that of group 1 (Likert scale =3.2 ± 1.4 vs. 3.3 ± 1.2, p = ns, in group 1 and 2, respectively). Coronary interpretability was high and similar between the two groups (97.5% and 97.1% in group 1 and 2, p = ns, respectively). Mean ED was significantly higher in group 1 than in group 2 (5.3 ± 1.8 mSv vs. 2.7 ± 0.7 mSv, p < 0.001)., Conclusion: The novel whole-heart coverage CT scanner allows to perform CCTA with a single-acquisition protocol with high image quality and low radiation exposure in AF patients., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Published
2019
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13. Diagnostic accuracy of coronary CT angiography performed in 100 consecutive patients with coronary stents using a whole-organ high-definition CT scanner.

Author

Andreini D, Pontone G, Mushtaq S, Conte E, Guglielmo M, Mancini ME, Annoni A, Baggiano A, Formenti A, Montorsi P, Magatelli M, Di Odoardo L, Melotti E, Resta M, Muscogiuri G, Fiorentini C, Bartorelli AL, and Pepi M

Subjects
Aged, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Coronary Restenosis physiopathology, Coronary Vessels surgery, Female, Follow-Up Studies, Heart Rate physiology, Humans, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Algorithms, Computed Tomography Angiography methods, Coronary Angiography methods, Coronary Restenosis diagnosis, Coronary Vessels diagnostic imaging, Stents
Abstract

Aims: To evaluate image quality, interpretability, diagnostic accuracy and radiation exposure of coronary CT angiography (CCTA) performed with a new scanner equipped with 0.23-mm spatial resolution, new generation iterative reconstruction, 0.28-second gantry rotation time and intra-cycle motion-correction algorithm in consecutive patients with coronary stents, including those with high heart rate (HR) and atrial fibrillation (AF)., Materials and Methods: We enrolled 100 consecutive patients (85 males, mean age 65 ± 10 years) with previous coronary stent implantation scheduled for clinically indicated non-emergent invasive coronary angiography (ICA). Image quality, coronary interpretability and diagnostic accuracy vs. ICA were evaluated and the effective dose (ED) was recorded., Results: Mean HR during the scan was 67 ± 13 bpm. Twenty-six patients had >65 bpm HR during scanning and 13 patients had AF. Overall, image quality was high (Likert = 3.2 ± 0.9). Stent interpretability was 95.8% (184/192 stents). Among 192 stented segments, CCTA correctly identified 22 out of 24 with >50% in-stent restenosis (ISR) (sensitivity 92%). In a stent-based analysis, specificity, positive and negative predictive values and diagnostic accuracy for ISR detection were 91%, 99%, 60% and 91%, respectively. In a patient-based analysis, CCTA diagnostic accuracy was 85%. Overall, mean ED of CCTA was 2.4 ± 1.2 mSv., Conclusions: A whole-organ CT scanner was able to evaluate coronary stents with good diagnostic performance and low radiation exposure, also in presence of unfavorable HR and heart rhythm., Translational Aspect: The present study is the first to evaluate the CCTA capability of detecting in-stent restenosis in consecutive patients, including those with high HR and AF, using a recent scanner generation that combines improved spatial and temporal resolution with wide coverage. Using the whole-organ high-definition CT scanner we obtained high quality images of coronary stents with good interpretability and diagnostic accuracy combined with low radiation exposure, even in patients with unfavorable HR or heart rhythm for CCTA evaluation., (Copyright © 2018. Published by Elsevier B.V.)

Published
2019
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14. Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study.

Author

Andreini D, Mushtaq S, Pontone G, Conte E, Sonck J, Collet C, Guglielmo M, Baggiano A, Trabattoni D, Galli S, Montorsi P, Ferrari C, Fabbiocchi F, De Martini S, Annoni A, Mancini ME, Formenti A, Magatelli M, Resta M, Consiglio E, Muscogiuri G, Fiorentini C, Bartorelli AL, and Pepi M

Subjects
Clinical Protocols, Coronary Restenosis etiology, Coronary Restenosis physiopathology, Humans, Percutaneous Coronary Intervention adverse effects, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Research Design, Computed Tomography Angiography, Coronary Angiography methods, Coronary Restenosis diagnostic imaging, Fractional Flow Reserve, Myocardial, Multidetector Computed Tomography, Myocardial Perfusion Imaging methods, Percutaneous Coronary Intervention instrumentation, Stents
Abstract

Background: Recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR). However, coronary stent assessment is still challenging, especially because of beam-hardening artifacts due to metallic stent struts and high atherosclerotic burden of non-stented segments. Adenosine-stress myocardial perfusion assessed by CT (CTP) recently demonstrated to be a feasible and accurate tool for evaluating the functional significance of coronary stenoses in patients with suspected coronary artery disease (CAD). Yet, scarce data are available on the performance of CTP in patients with previous stent implantation., Aim of the Study: We aim to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with a new scanner generation using quantitative invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as standard of reference., Methods: We will enroll 300 consecutive patients with previous stent implantation, referred for non-emergent and clinically indicated invasive coronary angiography (ICA) due to suspected ISR or progression of CAD in native coronary segments. All patients will be subjected to stress myocardial CTP and a rest CCTA. The first 150 subjects will undergo static CTP scan, while the following 150 patients will undergo dynamic CTP scan. Measurement of invasive FFR will be performed during ICA when clinically indicated., Results: The primary study end points will be: 1) assessment of the diagnostic performance (diagnostic rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. ICA as standard of reference in a territory-based and patient-based analysis; 2) assessment of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. invasive FFR as standard of reference in a territory-based analysis., Conclusions: The ADVANTAGE study aims to provide an answer to the intriguing question whether the combined anatomical and functional assessment with CCTA plus CTP may have higher diagnostic performance as compared to CCTA alone in identifying stented patients with significant ISR or CAD progression., (Copyright © 2018. Published by Elsevier Inc.)

Published
2018
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15. Percutaneous edge-to-edge mitral valve repair for the treatment of acute mitral regurgitation complicating myocardial infarction: A single centre experience.

Author

Adamo M, Curello S, Chiari E, Fiorina C, Chizzola G, Magatelli M, Locantore E, Cuminetti G, Lombardi C, Manzato A, Metra M, and Ettori F

Subjects
Acute Disease, Aged, Aged, 80 and over, Female, Follow-Up Studies, Hemodynamics, Humans, Italy, Male, Middle Aged, Myocardial Infarction diagnosis, Pulmonary Edema etiology, Pulmonary Edema therapy, Risk Assessment, Severity of Illness Index, Shock, Cardiogenic etiology, Shock, Cardiogenic therapy, Treatment Outcome, Cardiac Surgical Procedures methods, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve surgery, Mitral Valve Insufficiency diagnosis, Mitral Valve Insufficiency etiology, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency surgery, Myocardial Infarction complications
Abstract

Background: Limited evidence is available about MitraClip therapy in patients with acute mitral regurgitation (MR) complicating myocardial infarction (MI)., Methods and Results: Among 80 consecutive patients undergoing MitraClip treatment, 5 (6.3%) had been admitted for acute MI complicated by severe MR. Mean age was 73±6years and 3 were males. At the time of admission they were in cardiogenic shock (80%) or pulmonary oedema (20%), with severe MR, left ventricular dysfunction and pulmonary hypertension. The indication to MitraClip treatment was based on severe hemodynamic instability with dependence on intravenous therapy and mechanical supports despite percutaneous coronary revascularization and on high surgical risk of 27.1±13% and 10.2±6% using Euroscore II and STS score respectively. MitraClip procedure was performed at 53±33days from admission. One or two clips were employed in 2 and 3 patients respectively. Procedural success (MR≤2+) was achieved in all patients without complications and with successful weaning from mechanical supports and intravenous drugs in all but one patient who underwent left ventricular assist device implantation at 60days from MitraClip procedure. MR recurrence occurred at 30-day follow-up in one patient who had concomitant aortic regurgitation. One patient died during follow-up for non-cardiovascular cause. However, recovery of hemodynamic balance with significant and persistent pulmonary pressure reduction and functional status improvement up to 2-year follow-up was observed in most of the patients., Conclusions: Critical patients with acute ischemic MR post-MI with persistence of hemodynamic instability after coronary revascularization may benefit from MitraClip therapy acutely with favourable long-term follow-up results., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Published
2017
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16. Beta-blockers can improve survival in medically-treated patients with severe symptomatic aortic stenosis.

Author

Rossi A, Temporelli PL, Cicoira M, Gaibazzi N, Cioffi G, Nistri S, Magatelli M, Tavazzi L, and Faggiano P

Subjects
Aged, Aged, 80 and over, Aortic Valve Stenosis diagnosis, Female, Follow-Up Studies, Humans, Male, Retrospective Studies, Survival Rate trends, Treatment Outcome, Adrenergic beta-Antagonists therapeutic use, Aortic Valve Stenosis drug therapy, Aortic Valve Stenosis mortality, Severity of Illness Index
Published
2015
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17. A Type A Aortic Dissection Mimicking an Acute Myocardial Infarction.

Author

D'Aloia A, Vizzardi E, Bugatti S, Magatelli M, Bonadei I, Rovetta R, Quinzani F, Curnis A, and Cas LD

Abstract

We describe a case of a 54 years old man in whom an initial diagnosis of acute coronary syndrome (ACS) revealed to be finally an acute aortic dissection. This case report stresses the importance to maintain a high grade of suspicion of aortic dissection as a possible alternative in presence of eletrocardiographic myocardial ischemic signs. In many medical centers where thrombolitic therapy, antiplatelets receptor blockers, heparin or percutaneous coronary angioplasty is the first line therapy for ACS the outcome may be catastrophic in situation such as aortic dissection.

Published
2012
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