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Abstract Coronary computed tomography angiography (CCTA) derived machine learning fractional flow reserve (ML-FFRCT) can assess the hemodynamic significance of coronary artery stenoses. We aimed to assess sex differences in the association of ML-FFRCT and incident cardiovascular outcomes. We studied a retrospective cohort of consecutive patients who underwent clinically indicated CCTA and single photon emission computed tomography (SPECT). Obstructive stenosis was defined as ≥ 70% stenosis severity in non-left main vessels or ≥ 50% in the left main coronary. ML-FFRCT was computed using a machine learning algorithm with significant stenosis defined as ML-FFRCT

Transesophageal echocardiography is the main imaging modality for localizing and quantifying prosthetic aortic regurgitation. We describe a case of bioprosthetic aortic paravalvular leak (PVL) where transesophageal echocardiography was inadequate; aortic root angiography and computed tomography fusion were critical in diagnosing and guiding closure. Multimodality imaging can be pivotal in localizing PVL and guiding transcatheter PVL closure. (Level of Difficulty: Intermediate.)

Prosthetic valve thrombosis is the second leading cause of prosthetic valve deterioration and is being more readily diagnosed with the use of echocardiography and multidetector cardiac CT. Presentation of valve thrombosis can be acute or subacute and any change in clinical status of a patient with a prosthetic valve should raise a suspicion of prosthetic valve thrombosis. Diagnosis entails detailed clinical examination and comprehensive imaging. The choice of therapeutic options includes anticoagulation, fibrinolytic therapy, or valve replacement. Antiplatelet and anticoagulation therapy remain the mainstay of thrombosis prevention in patients with a prosthetic valve and a personalized approach is required to optimize prosthetic valve function and minimize the risk of bleeding.

A 54-year-old woman with a mechanical mitral valve replacement presented with recurrent admissions for pneumonia and pulmonary edema. Multimodality imaging revealed mobile masses on the prosthesis and discrepant point of care and inpatient international normalized ratio levels owing to antiphospholipid antibody cross-reactivity on the outpatient assay. The prosthetic valve thromboses resolved with therapeutic anticoagulation. (Level of Difficulty: Beginner.)

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 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]

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Background--3D stereolithographic printing can be used to convert high-resolution computed tomography images into life-size physical models. We sought to apply 3D printing technologies to develop patient-specific models of the anatomic and functional characteristics of severe aortic valve stenosis. Methods and Results--Eight patient-specific models of severe aortic stenosis (6 tricuspid and 2 bicuspid) were created using dual-material fused 3D printing. Tissue types were identified and segmented from clinical computed tomography image data. A rigid material was used for printing calcific regions, and a rubber-like material was used for soft tissue structures of the outflow tract, aortic root, and noncalcified valve cusps. Each model was evaluated for its geometric valve orifice area, echocardiographic image quality, and aortic stenosis severity by Doppler and Gorlin methods under 7 different in vitro stroke volume conditions. Fused multimaterial 3D printed models replicated the focal calcific structures of aortic stenosis. Doppler-derived measures of peak and mean transvalvular gradient correlated well with reference standard pressure catheters across a range of flow conditions (r=0.988 and r=0.978 respectively, P<0.001). Aortic valve orifice area by Gorlin and Doppler methods correlated well (r=0.985, P<0.001). Calculated aortic valve area increased a small amount for both methods with increasing flow (P=0.002). Conclusions--By combing the technologies of high-spatial resolution computed tomography, computer-aided design software, and fused dual-material 3D printing, we demonstrate that patient-specific models can replicate both the anatomic and functional properties of severe degenerative aortic valve stenosis. [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]

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]

End-stage renal disease (ESRD) is a growing global health problem with major health and economic implications. Cardiovascular complication is the major cause of morbidity and mortality in this population. Clustering of traditional atherosclerotic risk factors, such as diabetes, systemic inflammation, and altered mineral metabolism, contributes to enhanced systemic atherosclerosis in patients with ESRD. Prevalence of obstructive coronary artery disease (CAD) on coronary angiography exceeds 50% in this population. Despite having extensive CAD and vascular disease, patients with ESRD often do not present with classic symptoms because of impaired exercise capacity and diabetes. Furthermore, clinical trial data are exceedingly lacking in this population, resulting in considerable clinical equipoise regarding the optimal approach to the identification and subsequent management of CAD in these patients. Traditional clinical screening tools, including conventional risk prediction models, are significantly limited in their predictive accuracy for cardiovascular events in patients with ESRD. Noninvasive cardiac stress imaging modalities, such as nuclear perfusion and echocardiography, have been shown to improve the traditional clinical model in identifying the presence of CAD. Furthermore, they add incremental prognostic information to angiographic data. Novel imaging techniques and biomarker assays hold significant promise in further improving the ability to identify and risk-stratify for CAD. This review focuses on the current understanding of the clinical risk profile of asymptomatic patients with ESRD with an emphasis on the strengths and limitations of various noninvasive cardiovascular imaging modalities, including the role of novel methods in refining risk prediction. In addition, issues and challenges pertaining to the optimal timing of initial risk assessment ("screening") and possible repeat screening ("surveillance") are addressed. We also summarize the current data on the approach to the patient with ESRD being evaluated for transplantation in the context of recent guidelines and position statements by various professional societies. [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 discusses a study on the relative added value of epicardial adipose tissue volumes (EATv) or total intrathoracic fat volumes (ITFv) in stratifying risk among low to intermediate-risk patients who underwent coronary artery calcium score (CACS) tests for evaluation of acute chest pain (ACP). It describes computed tomography performed on patients with ACP admitted in the emergency department. Independent associations of CACS and fat volumes with major acute cardiac events are explored.

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.

The prevalence and outcomes of unrecognized left ventricular dysfunction (ULVSD) in patients with anemia and chronic kidney disease (CKD) is not known. The authors determined whether anemia (hemoglobin <13 g/L) and CKD (glomerular filtration rate <60 mL/min) are risk factors for ULVSD (ejection fraction <35%, no known heart failure [HF]) and to determine its impact on clinical outcomes. A total of 1358 patients without history of HF undergoing gated myocardial perfusion single photon emission computed tomography for evaluation of suspected coronary artery disease were followed for a mean of 2.15±0.8 years. End points were death and heart failure hospitalization (HFH). Patients were divided into 4 groups (I: no anemia/no CKD, n=752; II: CKD/no anemia, n=285; III: anemia/no CKD, n=153; IV: anemia+CKD, n=168). Compared with group I, LVSD was significantly more common in group IV (11.3% vs 4%; P=.0009). Death and HFH were significantly higher in group IV compared with group I (death rate for group I: 3.5% per year vs group IV: 12% per year; P<.0001) (HFH rate for group I: 1.5% per year vs group IV: 8% per year, P<.0001). Among patients with ejection fraction <35%, presence of anemia+CKD was associated with a relative risk of 2.48 (95% confidence interval, 1.13-5.4; P=.02) for death compared with group I. Among patients with ULVSD, only 65% were taking angiotensin enzyme inhibitors/angiotensin receptor blockers and β-blockers. ULVSD was almost 3 times more common in patients with anemia+CKD compared with those without and was associated with a significantly higher risk of death and HFH. It may therefore be beneficial to screen patients with anemia and CKD for ULVSD, since early therapy may improve outcomes. Congest Heart Fail. 2010;16:271-277. © 2010 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

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]

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 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.

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 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 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.

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).

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]

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]

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.