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2. Dose escalation for stereotactic arrhythmia radioablation of recurrent ventricular tachyarrhythmia - a phase II clinical trial

Author

Boldizsar Kovacs, Michael Mayinger, Stefanie Ehrbar, Debra Fesslmeier, Maiwand Ahmadsei, Lorraine Sazgary, Robert Manka, Hatem Alkadhi, Frank Ruschitzka, Firat Duru, Alexandros Papachristofilou, Christian Sticherling, Slawomir Blamek, Krzysztof S. Gołba, Matthias Guckenberger, Ardan M. Saguner, and Nicolaus Andratschke

Subjects
Stereotactic Arrhythmia Radioablation, Stereotactic body Radiotherapy, Ventricular tachycardia, Ventricular arrhythmia, Study protocol, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background Stereotactic arrhythmia radioablation (STAR) is delivered with a planning target volume (PTV) prescription dose of 25 Gy, mostly to the surrounding 75–85% isodose line. This means that the average and maximum dose received by the target is less than 35 Gy, which is the minimum threshold required to create a homogenous transmural fibrosis. Similar to catheter ablation, the primary objective of STAR should be transmural fibrosis to prevent heterogenous intracardiac conduction velocities and the occurrence of sustained ventricular arrhythmias (sVA) caused by reentry. We hypothesize that the current dose prescription used in STAR is inadequate for the long-term prevention of sVA and that a significant increase in dose is necessary to induce transmural scar formation. Objective A single arm, multi-center, phase II, dose escalation prospective clinical trial employing the i3 + 3 design is being conducted to examine the safety of a radiation dose-escalation strategy aimed at inducing transmural scar formation. The ultimate objective of this trial is to decrease the likelihood of sVA recurrence in patients at risk. Methods Patients with ischemic or non-ischemic cardiomyopathy and recurrent sVA, with an ICD and history of ≥ 1 catheter ablation for sVA will be included. This is a prospective, multicenter, one-arm, dose-escalation trial utilizing the i3 + 3 design, a modified 3 + 3 specifically created to overcome limitations in traditional dose-finding studies. A total of 15 patients will be recruited. The trial aims to escalate the ITV dose from 27.0 Gy to an ITV prescription dose-equivalent level of maximum 35.1 Gy by keeping the PTV prescription dose constant at 25 Gy while increasing the dose to the target (i.e. the VT substrate without PTV margin) by step-wise reduction of the prescribing isodose line (85% down to 65%). The primary outcome of this trial is safety measured by registered radiation associated adverse events (AE) up to 90 days after study intervention including radiation associated serious adverse events graded as at least 4 or 5 according to CTCAE v5, radiation pneumonitis or pericarditis requiring hospitalization and decrease in LVEF ≥ 10% as assessed by echocardiography or cardiac MRI at 90 days after STAR. The sample size was determined assuming an acceptable primary outcome event rate of 20%. Secondary outcomes include sVA burden at 6 months after STAR, time to first sVA recurrence, reduction in appropriate ICD therapies, the need for escalation of antiarrhythmic drugs, non-radiation associated safety and patient reported outcome measures such as SF-36 and EQ5D. Discussion DEFT-STAR is an innovative prospective phase II trial that aims to evaluate the optimal radiation dose for STAR in patients with therapy-refractory sVA. The trial has obtained IRB approval and focuses on determining the safe and effective radiation dose to be employed in the STAR procedure. Trial registration NCT05594368.

Published
2023
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3. Cardiac Angiosarcoma in the Right Atrium Treated by Surgical Resection

Author

Milica Dragicevic-Antonic, Ljiljana Rankovic-Nicic, Gordana Stamenkovic, Masa Petrovic, Goran Loncar, Nikola Markovic, Ana Dimitrijevic, Sulin Bulatovic, Milan Cirkovic, Branislava Borzanovic, Zelimir Antonic, Maja Pirnat, Robert Manka, and Milovan Bojic

Subjects
angiosarcoma, Takotsubo cardiomyopathy, cardiac magnetic resonance imaging, multidisciplinary approach, Medicine (General), R5-920
Abstract

We present the case of a 49-year-old female of Caucasian European descent with chest tightness, fatigue, and palpitations, ultimately diagnosed with primary intracardiac angiosarcoma. Initial echocardiography revealed a significant mass within the right atrium, infiltrating the free wall. Surgical intervention included tumor excision and partial resection of the superior vena cava. Histopathological examination confirmed a high-grade angiosarcoma. Postoperative imaging identified a recurrent mass in the right atrium, suggestive of thrombus, alongside Takotsubo cardiomyopathy. Considering the elevated surgical risks and the presence of cardiomyopathy, management included anticoagulation therapy with Warfarin and adjuvant chemotherapy with Paclitaxel. Follow-up cardiac magnetic resonance imaging demonstrated a recurrent angiosarcoma with superimposed thrombus. This case presents the complex diagnostic and therapeutic landscape of angiosarcoma, highlighting the critical importance of early surgical intervention, advanced imaging techniques, and vigilant postoperative monitoring.

Published
2024
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4. Virtual calcium removal in calcified coronary arteries with photon-counting detector CT—first in-vivo experience

Author

Victor Mergen, Stéphane Rusek, Filippo Civaia, Philippe Rossi, Rengarajan Rajagopal, Eduardo Bättig, Robert Manka, Alessandro Candreva, Matthias Eberhard, and Hatem Alkadhi

Subjects
coronary CT angiography (CCTA), coronary artery disease, calcified plaque, photon-counting detector CT (PCD-CT), spectral imaging, virtual non-calcium imaging, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

PurposeTo evaluate the feasibility and accuracy of quantification of calcified coronary stenoses using virtual non-calcium (VNCa) images in coronary CT angiography (CCTA) with photon-counting detector (PCD) CT compared with quantitative coronary angiography (QCA).Materials and methodsThis retrospective, institutional-review board approved study included consecutive patients with calcified coronary artery plaques undergoing CCTA with PCD-CT and invasive coronary angiography between July and December 2022. Virtual monoenergetic images (VMI) and VNCa images were reconstructed. Diameter stenoses were quantified on VMI and VNCa images by two readers. 3D-QCA served as the standard of reference. Measurements were compared using Bland-Altman analyses, Wilcoxon tests, and intraclass correlation coefficients (ICC).ResultsThirty patients [mean age, 64 years ± 8 (standard deviation); 26 men] with 81 coronary stenoses from calcified plaques were included. Ten of the 81 stenoses (12%) had to be excluded because of erroneous plaque subtraction on VNCa images. Median diameter stenosis determined on 3D-QCA was 22% (interquartile range, 11%–35%; total range, 4%–88%). As compared with 3D-QCA, VMI overestimated diameter stenoses (mean differences −10%, p

Published
2024
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5. Spontaneous Dissection of a Septal Coronary Artery Mimicking Myocarditis

Author

Mihály Károlyi, MD, PhD, Christian Templin, MD, PhD, Hatem Alkadhi, MD, MPH, and Robert Manka, MD

Subjects
acute coronary syndrome, cardiac magnetic resonance, computed tomography, dissection, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Acute chest pain and dyspnea often raise coronary disease suspicion. When echocardiography and cardiac computed tomography findings appear normal, alternative diagnoses should be explored. We present a case initially suggestive of myocarditis but later revealed as coronary dissection by cardiac magnetic resonance. This case emphasizes the role of advanced imaging in atypical cardiac presentations.

Published
2024
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11. Impact of late gadolinium enhancement image acquisition resolution on neural network based automatic scar segmentation

Author

Tobias Hoh, Isabel Margolis, Jonathan Weine, Thomas Joyce, Robert Manka, Miriam Weisskopf, Nikola Cesarovic, Maximilian Fuetterer, and Sebastian Kozerke

Subjects
Cardiovascular magnetic resonance, LGE imaging, Scar quantification, Neural networks, Deep learning, Automatic segmentation, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Automatic myocardial scar segmentation from late gadolinium enhancement (LGE) images using neural networks promises an alternative to time-consuming and observer-dependent semi-automatic approaches. However, alterations in data acquisition, reconstruction as well as post-processing may compromise network performance. The objective of the present work was to systematically assess network performance degradation due to a mismatch of point-spread function between training and testing data. Methods: Thirty-six high-resolution (0.7×0.7×2.0 mm3) LGE k-space datasets were acquired post-mortem in porcine models of myocardial infarction. The in-plane point-spread function and hence in-plane resolution Δx was retrospectively degraded using k-space lowpass filtering, while field-of-view and matrix size were kept constant. Manual segmentation of the left ventricle (LV) and healthy remote myocardium was performed to quantify location and area (% of myocardium) of scar by thresholding (≥ SD5 above remote). Three standard U-Nets were trained on training resolutions Δxtrain = 0.7, 1.2 and 1.7 mm to predict endo- and epicardial borders of LV myocardium and scar. The scar prediction of the three networks for varying test resolutions (Δxtest = 0.7 to 1.7 mm) was compared against the reference SD5 thresholding at 0.7 mm. Finally, a fourth network trained on a combination of resolutions (Δxtrain = 0.7 to 1.7 mm) was tested. Results: The prediction of relative scar areas showed the highest precision when the resolution of the test data was identical to or close to the resolution used during training. The median fractional scar errors and precisions (IQR) from networks trained and tested on the same resolution were 0.0 percentage points (p.p.) (1.24 - 1.45), and − 0.5 - 0.0 p.p. (2.00 – 3.25) for networks trained and tested on the most differing resolutions, respectively. Deploying the network trained on multiple resolutions resulted in reduced resolution dependency with median scar errors and IQRs of 0.0 p.p. (1.24 – 1.69) for all investigated test resolutions. Conclusion: A mismatch of the imaging point-spread function between training and test data can lead to degradation of scar segmentation when using current U-Net architectures as demonstrated on LGE porcine myocardial infarction data. Training networks on multi-resolution data can alleviate the resolution dependency.

Published
2024
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12. Mid- to long-term cardiac magnetic resonance findings in elite athletes recovered from COVID-19: results from an ongoing observational COVID-19 study at a German Olympic medical centre

Author

Christopher Schneeweis, Katharina Diebold, Thomas Schramm, Christine Syrek, Hans-Georg Predel, Robert Manka, and Jonas Zacher

Subjects
Medicine
Abstract

INTRODUCTION: The cardiac magnetic resonance (CMR) data on mid- to long-term myocardial damage due to COVID-19 infections in elite athletes are scarce. Therefore, this study investigated the mid -to long-term consequences of myocardial involvement after a COVID-19 infection in elite athletes. MATERIALS AND METHODS: This study included 27 athletes at the German Olympic Centre North Rhine-Westphalia (NRW)/Rhineland with a confirmed previous COVID-19 infection between January 2020 and October 2021. The athletes were part of an ongoing observational COVID-19 study at the Institute of Cardiology and Sports Medicine Cologne at the German Sport University (DSHS).Nine healthy non-athletes with no prior COVID-19 illness served as controls. CMR was performed within a mean of 182 days (standard deviation [SD] 99) of the initial positive test result. RESULTS: CMR did not reveal any signs of acute myocarditis (according to the current Lake Louise criteria) or myocardial damage in any of the 26 elite athletes with previous COVID-19 infection. Of these athletes, 92% experienced a symptomatic course, and 54% reported symptoms lasting for more than 4 weeks. One male athlete was excluded from the analysis because CMR revealed an arrhythmogenic right ventricular cardiomyopathy (ARVC). Athletes had significantly enlarged left and right ventricle volumes and increased left ventricular myocardial mass in comparison to the healthy control group (LVEDVi 103.4 vs 91.1 ml/m2, p = 0.031; RVEDVi 104.1 vs 86.6 ml/m2, p = 0.007; LVMi 59.0 vs 46.2 g/m2, p = 0.002). Only two cases of elevated high-sensitivity-Troponin were documented; in one, the participant had previously engaged in high-intensity training, and in the other, CMR revealed a diagnosis of an arrhythmogenic cardiomyopathy. CONCLUSION: Our findings suggest that the risk for mid- to long-term myocardial damage is very low to negligible in elite athletes. Our results do not allow conclusions to be drawn regarding myocardial injury in the acute phase of infection nor about possible long-term myocardial effects in the general population.

Published
2023
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13. A comparative study on the analysis of hemodynamics in the athlete’s heart

Author

Utku Gülan, Valentina A. Rossi, Alexander Gotschy, Ardan M. Saguner, Robert Manka, Corinna B. Brunckhorst, Firat Duru, Christian M. Schmied, and David Niederseer

Subjects
Medicine, Science
Abstract

Abstract The pathophysiological mechanisms underlying the development of the athlete’s heart are still poorly understood. To characterize the intracavitary blood flows in the right ventricle (RV) and right-ventricular outflow tract (RVOT) in 2 healthy probands, patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and 2 endurance athletes, we performed 4D-MRI flow measurements to assess differences in kinetic energy and shear stresses. Time evolution of velocity magnitude, mean kinetic energy (MKE), turbulent kinetic energy (TKE) and viscous shear stress (VSS) were measured both along the whole RV and in the RVOT. RVOT regions had higher kinetic energy values and higher shear stresses levels compared to the global averaging over RV among all subjects. Endurance athletes had relatively lower kinetic energy and shear stresses in the RVOT regions compared to both healthy probands and ARVC patients. The athlete’s heart is characterized by lower kinetic energy and shear stresses in the RVOT, which might be explained by a higher diastolic compliance of the RV.

Published
2022
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14. Segmental strain for scar detection in acute myocardial infarcts and in follow-up exams using non-contrast CMR cine sequences

Author

Malgorzata Polacin, Mihaly Karolyi, Matthias Eberhard, Ioannis Matziris, Hatem Alkadhi, Sebastian Kozerke, and Robert Manka

Subjects
Cardiac magnetic resonance, Acute myocardial infarction, Ischemic heart disease, Feature tracking, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background The purpose of the study was to investigate feasibility of infarct detection in segmental strain derived from non-contrast cardiac magnetic resonance (CMR) cine sequences in patients with acute myocardial infarction (AMI) and in follow-up (FU) exams. Methods 57 patients with AMI (mean age 61 ± 12 years, CMR 2.8 ± 2 days after infarction) were retrospectively included, FU exams were available in 32 patients (35 ± 14 days after first CMR). 43 patients with normal CMR (54 ± 11 years) served as controls. Dedicated software (Segment CMR, Medviso) was used to calculate global and segmental strain derived from cine sequences. Cine short axis stacks and segmental circumferential strain calculations of every patient and control were presented to two blinded readers in random order, who were advised to identify potentially infarcted segments, blinded to LGE and clinical information. Results Impaired global strain was measured in AMI patients compared to controls (global peak circumferential strain [GPCS] p = 0.01; global peak longitudinal strain [GPLS] p = 0.04; global peak radial strain [GPRS] p = 0.01). In both imaging time points, mean segmental peak circumferential strain [SPCS] was impaired in infarcted tissue compared to remote segments (AMI: p = 0.03, FU: p = 0.02). SPCS values in infarcted segments were similar between AMI and FU (p = 0.8). In SPCS calculations, 141 from 189 acutely infarcted segments were accurately detected (74.6%), visual evaluation of correlating cine images detected 43.4% infarcts. In FU, 80% infarcted segments (91/114 segments) were detected in SPCS and 51.8% by visual evaluation of correlating short axis cine images (p = 0.01). Conclusion Segmental circumferential strain derived from routinely acquired native cine sequences detects nearly 75% of acute infarcts and 80% of infarcts in subacute follow-up CMR, significantly more than visual evaluation of correlating cine images alone. Acute infarcts may display only subtle impairment of wall motion and no obvious wall thinning, thus SPCS calculation might be helpful for scar detection in patients with acute infarcts, when LGE images are not available.

Published
2022
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15. Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia

Author

Takashi Kudo, MD, PhD, Ryan Lahey, MD, PhD, Cole B. Hirschfeld, MD, Michelle C. Williams, MBChB, PhD, Bin Lu, MD, PhD, Mirvat Alasnag, MD, Mona Bhatia, MD, Hee-Seung Henry Bom, MD, PhD, Tairkhan Dautov, MD, Reza Fazel, MD, MSc, Ganesan Karthikeyan, MD, Felix Y.J. Keng, MBBS, Ronen Rubinshtein, MD, Nathan Better, MBBS, Rodrigo Julio Cerci, MD, Sharmila Dorbala, MD, MPH, Paolo Raggi, MD, Leslee J. Shaw, PhD, Todd C. Villines, MD, João V. Vitola, MD, PhD, Andrew D. Choi, MD, Eli Malkovskiy, Benjamin Goebel, BS, Yosef A. Cohen, BA, Michael Randazzo, MD, Thomas N.B. Pascual, MD, Yaroslav Pynda, MSc, Maurizio Dondi, MD, PhD, Diana Paez, MD, MEd, Andrew J. Einstein, MD, PhD, Andrew J. Einstein, Diana Paez, Maurizio Dondi, Nathan Better, Rodrigo Cerci, Sharmila Dorbala, Thomas N.B. Pascual, Paolo Raggi, Leslee J. Shaw, Todd C. Villines, Joao V. Vitola, Michelle C. Williams, Yaroslav Pynda, Gerd Hinterleitner, Yao Lu, Olga Morozova, Zhuoran Xu, Cole B. Hirschfeld, Yosef Cohen, Benjamin Goebel, Michael Randazzo, Andrew Choi, Juan Lopez-Mattei, Purvi Parwani, Mohammad Nawaz Nasery, Artan Goda, Ervina Shirka, Rabie Benlabgaa, Salah Bouyoucef, Abdelkader Medjahedi, Qais Nailli, Mariela Agolti, Roberto Nicolas Aguero, Maria del Carmen Alak, Lucia Graciela Alberguina, Guillermo Arroñada, Andrea Astesiano, Alfredo Astesiano, Carolina Bas Norton, Pablo Benteo, Juan Blanco, Juan Manuel Bonelli, Jose Javier Bustos, Raul Cabrejas, Jorge Cachero, Roxana Campisi, Alejandro Canderoli, Silvia Carames, Patrícia Carrascosa, Ricardo Castro, Oscar Cendoya, Luciano Martin Cognigni, Carlos Collaud, Claudia Cortes, Javier Courtis, Daniel Cragnolino, Mariana Daicz, Alejandro De La Vega, Silvia Teresa De Maria, Horacio Del Riego, Fernando Dettori, Alejandro Deviggiano, Laura Dragonetti, Mario Embon, Ruben Emilio Enriquez, Jorge Ensinas, Fernando Faccio, Adolfo Facello, Diego Garofalo, Ricardo Geronazzo, Natalia Gonza, Lucas Gutierrez, Miguel Angel Guzzo, Victor Hasbani, Melina Huerin, Victor Jäger, Julio Manuel Lewkowicz, Maria Nieves A. López De Munaín, Jose Maria Lotti, Alejandra Marquez, Osvaldo Masoli, Osvaldo Horacio Masoli, Edgardo Mastrovito, Matias Mayoraz, Graciela Eva Melado, Anibal Mele, Maria Fernanda Merani, Alejandro Horacio Meretta, Susana Molteni, Marcos Montecinos, Eduardo Noguera, Carlos Novoa, Claudio Pereyra Sueldo, Sebastian Perez Ascani, Pablo Pollono, Maria Paula Pujol, Alejandro Radzinschi, Gustavo Raimondi, Marcela Redruello, Marina Rodríguez, Matías Rodríguez, Romina Lorena Romero, Arturo Romero Acuña, Federico Rovaletti, Lucas San Miguel, Lucrecia Solari, Bruno Strada, Sonia Traverso, Sonia Simona Traverzo, Maria del Huerto Velazquez Espeche, Juan Sebastian Weihmuller, Juan Wolcan, Susana Zeffiro, Mari Sakanyan, Scott Beuzeville, Raef Boktor, Patrick Butler, Jennifer Calcott, Loretta Carr, Virgil Chan, Charles Chao, Woon Chong, Mark Dobson, D'Arne Downie, Girish Dwivedi, Barry Elison, Jean Engela, Roslyn Francis, Anand Gaikwad, Ashok Gangasandra Basavaraj, Bruce Goodwin, Robert Greenough, Christian Hamilton-Craig, Victar Hsieh, Subodh Joshi, Karin Lederer, Kenneth Lee, Joseph Lee, John Magnussen, Nghi Mai, Gordon Mander, Fiona Murton, Dee Nandurkar, Johanne Neill, Edward O'Rourke, Patricia O'Sullivan, George Pandos, Kunthi Pathmaraj, Alexander Pitman, Rohan Poulter, Manuja Premaratne, David Prior, Lloyd Ridley, Natalie Rutherford, Hamid Salehi, Connor Saunders, Luke Scarlett, Sujith Seneviratne, Deepa Shetty, Ganesh Shrestha, Jonathan Shulman, Vijay Solanki, Tony Stanton, Murch Stuart, Michael Stubbs, Ian Swainson, Kim Taubman, Andrew Taylor, Paul Thomas, Steven Unger, Anthony Upton, Shankar Vamadevan, William Van Gaal, Johan Verjans, Demetrius Voutnis, Victor Wayne, Peter Wilson, David Wong, Kirby Wong, John Younger, Gudrun Feuchtner, Siroos Mirzaei, Konrad Weiss, Natallia Maroz-Vadalazhskaya, Olivier Gheysens, Filip Homans, Rodrigo Moreno-Reyes, Agnès Pasquet, Veronique Roelants, Caroline M. Van De Heyning, Raúl Araujo Ríos, Valentina Soldat-Stankovic, Sinisa Stankovic, Maria Helena Albernaz Siqueira, Augusto Almeida, Paulo Henrique Alves Togni, Jose Henrique Andrade, Luciana Andrade, Carlos Anselmi, Roberta Araújo, Guilherme Azevedo, Sabbrina Bezerra, Rodrigo Biancardi, Gabriel Blacher Grossman, Simone Brandão, Diego Bromfman Pianta, Lara Carreira, Bruno Castro, Tien Chang, Fernando Cunali, Jr., Roberto Cury, Roberto Dantas, Fernando de Amorim Fernandes, Andrea De Lorenzo, Robson De Macedo Filho, Fernanda Erthal, Fabio Fernandes, Juliano Fernandes, Thiago Ferreira De Souza, Wilson Furlan Alves, Bruno Ghini, Luiz Goncalves, Ilan Gottlieb, Marcelo Hadlich, Vinícius Kameoka, Ronaldo Lima, Adna Lima, Rafael Willain Lopes, Ricardo Machado e Silva, Tiago Magalhães, Fábio Martins Silva, Luiz Eduardo Mastrocola, Fábio Medeiros, José Claudio Meneghetti, Vania Naue, Danilo Naves, Roberto Nolasco, Cesar Nomura, Joao Bruno Oliveira, Eduardo Paixao, Filipe Penna De Carvalho, Ibraim Pinto, Priscila Possetti, Mayra Quinta, Rodrigo Rizzo Nogueira Ramos, Ricardo Rocha, Alfredo Rodrigues, Carlos Rodrigues, Leila Romantini, Adelina Sanches, Sara Santana, Leonardo Sara da Silva, Paulo Schvartzman, Cristina Sebastião Matushita, Tiago Senra, Afonso Shiozaki, Maria Eduarda Menezes de Siqueira, Cristiano Siqueira, Paola Smanio, Carlos Eduardo Soares, José Soares Junior, Marcio Sommer Bittencourt, Bernardo Spiro, Cláudio Tinoco Mesquita, Jorge Torreao, Rafael Torres, Marly Uellendahl, Guilherme Urpia Monte, Otávia Veríssimo, Estevan Vieira Cabeda, Felipe Villela Pedras, Roberto Waltrick, Marcello Zapparoli, Hamid Naseer, Marina Garcheva-Tsacheva, Irena Kostadinova, Youdaline Theng, Gad Abikhzer, Rene Barette, Benjamin Chow, Dominique Dabreo, Matthias Friedrich, Ria Garg, Mohammed Nassoh Hafez, Chris Johnson, Marla Kiess, Jonathon Leipsic, Eugene Leung, Robert Miller, Anastasia Oikonomou, Stephan Probst, Idan Roifman, Gary Small, Vikas Tandon, Adwait Trivedi, James White, Katherine Zukotynski, Jose Canessa, Gabriel Castro Muñoz, Carmen Concha, Pablo Hidalgo, Cesar Lovera, Teresa Massardo, Luis Salazar Vargas, Pedro Abad, Harold Arturo, Sandra Ayala, Luis Benitez, Alberto Cadena, Carlos Caicedo, Antonio Calderón Moncayo, Sharon Gomez, Claudia T. Gutierrez Villamil, Claudia Jaimes, Juan Londoño, Juan Luis Londoño Blair, Luz Pabon, Mauricio Pineda, Juan Carlos Rojas, Diego Ruiz, Manuel Valencia Escobar, Andres Vasquez, Damiana Vergel, Alejandro Zuluaga, Isabel Berrocal Gamboa, Gabriel Castro, Ulises González, Ana Baric, Tonci Batinic, Maja Franceschi, Maja Hrabak Paar, Mladen Jukic, Petar Medakovic, Viktor Persic, Marina Prpic, Ante Punda, Juan Felipe Batista, Juan Manuel Gómez Lauchy, Yamile Marcos Gutierrez, Rayner Menéndez, Amalia Peix, Luis Rochela, Christoforos Panagidis, Ioannis Petrou, Vaclav Engelmann, Milan Kaminek, Vladimír Kincl, Otto Lang, Milan Simanek, Jawdat Abdulla, Morten Bøttcher, Mette Christensen, Lars Christian Gormsen, Philip Hasbak, Søren Hess, Paw Holdgaard, Allan Johansen, Kasper Kyhl, Bjarne Linde Norgaard, Kristian Altern Øvrehus, Niels Peter Rønnow Sand, Rolf Steffensen, Anders Thomassen, Bo Zerahn, Alfredo Perez, Giovanni Alejandro Escorza Velez, Mayra Sanchez Velez, Islam Shawky Abdel Aziz, Mahasen Abougabal, Taghreed Ahmed, Adel Allam, Ahmed Asfour, Mona Hassan, Alia Hassan, Ahmed Ibrahim, Sameh Kaffas, Ahmed Kandeel, Mohamed Mandour Ali, Ahmad Mansy, Hany Maurice, Sherif Nabil, Mahmoud Shaaban, Ana Camila Flores, Anne Poksi, Juhani Knuuti, Velipekka Kokkonen, Martti Larikka, Valtteri Uusitalo, Matthieu Bailly, Samuel Burg, Jean-François Deux, Vincent Habouzit, Fabien Hyafil, Olivier Lairez, Franck Proffit, Hamza Regaieg, Laure Sarda-Mantel, Vania Tacher, Roman P. Schneider, Harold Ayetey, George Angelidis, Aikaterini Archontaki, Sofia Chatziioannou, Ioannis Datseris, Christina Fragkaki, Panagiotis Georgoulias, Sophia Koukouraki, Maria Koutelou, Eleni Kyrozi, Evangelos Repasos, Petros Stavrou, Pipitsa Valsamaki, Carla Gonzalez, Goleat Gutierrez, Alejandro Maldonado, Klara Buga, Ildiko Garai, Pál Maurovich-Horvat, Erzsébet Schmidt, Balint Szilveszter, Edit Várady, Nilesh Banthia, Jinendra Kumar Bhagat, Rishi Bhargava, Vivek Bhat, Mona Bhatia, Partha Choudhury, Vijay Sai Chowdekar, Aparna Irodi, Shashank Jain, Elizabeth Joseph, Sukriti Kumar, Prof Dr Girijanandan Mahapatra, Deepanjan Mitra, Bhagwant Rai Mittal, Ahmad Ozair, Chetan Patel, Tapan Patel, Ravi Patel, Shivani Patel, Sudhir Saxena, Shantanu Sengupta, Santosh Singh, Bhanupriya Singh, Ashwani Sood, Atul Verma, Erwin Affandi, Padma Savenadia Alam, Edison Edison, Gani Gunawan, Habusari Hapkido, Basuki Hidayat, Aulia Huda, Anggoro Praja Mukti, Djoko Prawiro, Erwin Affandi Soeriadi, Hilman Syawaluddin, Amjed Albadr, Majid Assadi, Farshad Emami, Golnaz Houshmand, Majid Maleki, Maryam Tajik Rostami, Seyed Rasoul Zakavi, Eed Abu Zaid, Svetlana Agranovich, Yoav Arnson, Rachel Bar-Shalom, Alex Frenkel, Galit Knafo, Rachel Lugassi, Israel Shlomo Maor Moalem, Maya Mor, Noam Muskal, Sara Ranser, Aryeh Shalev, Domenico Albano, Pierpaolo Alongi, Gaspare Arnone, Elisa Bagatin, Sergio Baldari, Matteo Bauckneht, Paolo Bertelli, Francesco Bianco, Rachele Bonfiglioli, Roberto Boni, Andrea Bruno, Isabella Bruno, Elena Busnardo, Elena Califaretti, Luca Camoni, Aldo Carnevale, Roberta Casoni, Armando Ugo Cavallo, Giorgio Cavenaghi, Franca Chierichetti, Marcello Chiocchi, Corrado Cittanti, Mauro Colletta, Umberto Conti, Alberto Cossu, Alberto Cuocolo, Marco Cuzzocrea, Maria Luisa De Rimini, Giuseppe De Vincentis, Eleonora Del Giudice, Alberico Del Torto, Veronica Della Tommasina, Rexhep Durmo, Paola Anna Erba, Laura Evangelista, Riccardo Faletti, Evelina Faragasso, Mohsen Farsad, Paola Ferro, Luigia Florimonte, Viviana Frantellizzi, Fabio Massimo Fringuelli, Marco Gatti, Angela Gaudiano, Alessia Gimelli, Raffaele Giubbini, Francesca Giuffrida, Salvatore Ialuna, Riccardo Laudicella, Lucia Leccisotti, Lucia Leva, Riccardo Liga, Carlo Liguori, Giampiero Longo, Margherita Maffione, Maria Elisabetta Mancini, Claudio Marcassa, Elisa Milan, Barbara Nardi, Sara Pacella, Giovanna Pepe, Gianluca Pontone, Sabina Pulizzi, Natale Quartuccio, Lucia Rampin, Fabrizio Ricci, Pierluigi Rossini, Giuseppe Rubini, Vincenzo Russo, Gian Mauro Sacchetti, Gianmario Sambuceti, Massimo Scarano, Roberto Sciagrà, Massimiliano Sperandio, Antonella Stefanelli, Guido Ventroni, Stefania Zoboli, Dainia Baugh, Duane Chambers, Ernest Madu, Felix Nunura, Hiroshi Asano, Chimura Misato Chimura, Shinichiro Fujimoto, Koichiro Fujisue, Tomohisa Fukunaga, Yoshimitsu Fukushima, Kae Fukuyama, Jun Hashimoto, Yasutaka Ichikawa, Nobuo Iguchi, Masamichi Imai, Anri Inaki, Hayato Ishimura, Satoshi Isobe, Toshiaki Kadokami, Takao Kato, Takashi Kudo, Shinichiro Kumita, Hirotaka Maruno, Hiroyuki Mataki, Masao Miyagawa, Ryota Morimoto, Masao Moroi, Shigeki Nagamachi, Kenichi Nakajima, Tomoaki Nakata, Ryo Nakazato, Mamoru Nanasato, Masanao Naya, Takashi Norikane, Yasutoshi Ohta, Satoshi Okayama, Atsutaka Okizaki, Yoichi Otomi, Hideki Otsuka, Masaki Saito, Sakata Yasushi Sakata, Masayoshi Sarai, Daisuke Sato, Shinya Shiraishi, Yoshinobu Suwa, Kentaro Takanami, Kazuya Takehana, Junichi Taki, Nagara Tamaki, Yasuyo Taniguchi, Hiroki Teragawa, Nobuo Tomizawa, Kenichi Tsujita, Kyoko Umeji, Yasushi Wakabayashi, Shinichiro Yamada, Shinya Yamazaki, Tatsuya Yoneyama, Mohammad Rawashdeh, Daultai Batyrkhanov, Tairkhan Dautov, Khalid Makhdomi, Kevin Ombati, Faridah Alkandari, Masoud Garashi, Tchoyoson Lim Coie, Sonexay Rajvong, Artem Kalinin, Marika Kalnina, Mohamad Haidar, Renata Komiagiene, Giedre Kviecinskiene, Mindaugas Mataciunas, Donatas Vajauskas, Christian Picard, Noor Khairiah A. Karim, Luise Reichmuth, Anthony Samuel, Mohammad Aaftaab Allarakha, Ambedhkar Shantaram Naojee, Erick Alexanderson-Rosas, Erika Barragan, Alejandro Becerril González-Montecinos, Manuel Cabada, Daniel Calderon Rodriguez, Isabel Carvajal-Juarez, Violeta Cortés, Filiberto Cortés, Erasmo De La Peña, Manlio Gama-Moreno, Luis González, Nelsy Gonzalez Ramírez, Moisés Jiménez-Santos, Luis Matos, Edgar Monroy, Martha Morelos, Mario Ornelas, Jose Alberto Ortga Ramirez, Andrés Preciado-Anaya, Óscar Ulises Preciado-Gutiérrez, Adriana Puente Barragan, Sandra Graciela Rosales Uvera, Sigelinda Sandoval, Miguel Santaularia Tomas, Lilia M. Sierra-Galan, Silvia Siu, Enrique Vallejo, Mario Valles, Marc Faraggi, Erdenechimeg Sereegotov, Srdja Ilic, Nozha Ben-Rais, Nadia Ismaili Alaoui, Sara Taleb, Khin Pa Pa Myo, Phyo Si Thu, Ram Kumar Ghimire, Bijoy Rajbanshi, Peter Barneveld, Andor Glaudemans, Jesse Habets, Klaas Pieter Koopmans, Jeroen Manders, Stefan Pool, Arthur Scholte, Asbjørn Scholtens, Riemer Slart, Paul Thimister, Erik-Jan Van Asperen, Niels Veltman, Derk Verschure, Nils Wagenaar, John Edmond, Chris Ellis, Kerryanne Johnson, Ross Keenan, Shaw Hua (Anthony) Kueh, Christopher Occleshaw, Alexander Sasse, Andrew To, Niels Van Pelt, Calum Young, Teresa Cuadra, Hector Bladimir Roque Vanegas, Idrissa Adamou Soli, Djibrillou Moussa Issoufou, Tolulope Ayodele, Chibuzo Madu, Yetunde Onimode, Elen Efros-Monsen, Signe Helene Forsdahl, Jenni-Mari Hildre Dimmen, Arve Jørgensen, Isabel Krohn, Pål Løvhaugen, Anders Tjellaug Bråten, Humoud Al Dhuhli, Faiza Al Kindi, Naeema Al-Bulushi, Zabah Jawa, Naima Tag, Muhammad Shehzad Afzal, Shazia Fatima, Muhammad Numair Younis, Musab Riaz, Mohammad Saadullah, Yariela Herrera, Dora Lenturut-Katal, Manuel Castillo Vázquez, José Ortellado, Afroza Akhter, Dianbo Cao, Stephen Cheung, Xu Dai, Lianggeng Gong, Dan Han, Yang Hou, Caiying Li, Tao Li, Dong Li, Sijin Li, Jinkang Liu, Hui Liu, Bin Lu, Ming Yen Ng, Kai Sun, Gongshun Tang, Jian Wang, Ximing Wang, Zhao-Qian Wang, Yining Wang, Yifan Wang, Jiang Wu, Zhifang Wu, Liming Xia, Jiangxi Xiao, Lei Xu, Youyou Yang, Wu Yin, Jianqun Yu, Li Yuan, Tong Zhang, Longjiang Zhang, Yong-Gao Zhang, Xiaoli Zhang, Li Zhu, Ana Alfaro, Paz Abrihan, Asela Barroso, Eric Cruz, Marie Rhiamar Gomez, Vincent Peter Magboo, John Michael Medina, Jerry Obaldo, Davidson Pastrana, Christian Michael Pawhay, Alvin Quinon, Jeanelle Margareth Tang, Bettina Tecson, Kristine Joy Uson, Mila Uy, Magdalena Kostkiewicz, Jolanta Kunikowska, Nuno Bettencourt, Guilhermina Cantinho, Antonio Ferreira, Ghulam Syed, Samer Arnous, Said Atyani, Angela Byrne, Tadhg Gleeson, David Kerins, Conor Meehan, David Murphy, Mark Murphy, John Murray, Julie O'Brien, Ji-In Bang, Henry Bom, Sang-Geon Cho, Chae Moon Hong, Su Jin Jang, Yong Hyu Jeong, Won Jun Kang, Ji-Young Kim, Jaetae Lee, Chang Kyeong Namgung, Young So, Kyoung Sook Won, Venjamin Majstorov, Marija Vavlukis, Barbara Gužic Salobir, Monika Štalc, Theodora Benedek, Imre Benedek, Raluca Mititelu, Claudiu Adrian Stan, Alexey Ansheles, Olga Dariy, Olga Drozdova, Nina Gagarina, Vsevolod Milyevich Gulyaev, Irina Itskovich, Anatoly Karalkin, Alexander Kokov, Ekaterina Migunova, Viktor Pospelov, Daria Ryzhkova, Guzaliya Saifullina, Svetlana Sazonova, Vladimir Sergienko, Irina Shurupova, Tatjana Trifonova, Wladimir Yurievich Ussov, Margarita Vakhromeeva, Nailya Valiullina, Konstantin Zavadovsky, Kirill Zhuravlev, Mirvat Alasnag, Subhani Okarvi, Dragana Sobic Saranovic, Felix Keng, Jia Hao Jason See, Ramkumar Sekar, Min Sen Yew, Andrej Vondrak, Shereen Bejai, George Bennie, Ria Bester, Gerrit Engelbrecht, Osayande Evbuomwan, Harlem Gongxeka, Magritha Jv Vuuren, Mitchell Kaplan, Purbhoo Khushica, Hoosen Lakhi, Lizette Louw, Nico Malan, Katarina Milos, Moshe Modiselle, Stuart More, Mathava Naidoo, Leonie Scholtz, Mboyo Vangu, Santiago Aguadé-Bruix, Isabel Blanco, Antonio Cabrera, Alicia Camarero, Irene Casáns-Tormo, Hug Cuellar-Calabria, Albert Flotats, Maria Eugenia Fuentes Cañamero, María Elia García, Amelia Jimenez-Heffernan, Rubén Leta, Javier Lopez Diaz, Luis Lumbreras, Juan Javier Marquez-Cabeza, Francisco Martin, Anxo Martinez de Alegria, Francisco Medina, Maria Pedrera Canal, Virginia Peiro, Virginia Pubul-Nuñez, Juan Ignacio Rayo Madrid, Cristina Rodríguez Rey, Ricardo Ruano Perez, Joaquín Ruiz, Gertrudis Sabatel Hernández, Ana Sevilla, Nahla Zeidán, Damayanthi Nanayakkara, Chandraguptha Udugama, Magnus Simonsson, Hatem Alkadhi, Ronny Ralf Buechel, Peter Burger, Luca Ceriani, Bart De Boeck, Christoph Gräni, Alix Juillet de Saint Lager Lucas, Christel H. Kamani, Nadine Kawel-Boehm, Robert Manka, John O. Prior, Axel Rominger, Jean-Paul Vallée, Benjapa Khiewvan, Teerapon Premprabha, Tanyaluck Thientunyakit, Ali Sellem, Kemal Metin Kir, Haluk Sayman, Mugisha Julius Sebikali, Zerida Muyinda, Yaroslav Kmetyuk, Pavlo Korol, Olena Mykhalchenko, Volodymyr Pliatsek, Maryna Satyr, Batool Albalooshi, Mohamed Ismail Ahmed Hassan, Jill Anderson, Punit Bedi, Thomas Biggans, Anda Bularga, Russell Bull, Rajesh Burgul, John-Paul Carpenter, Duncan Coles, David Cusack, Aparna Deshpande, John Dougan, Timothy Fairbairn, Alexia Farrugia, Deepa Gopalan, Alistair Gummow, Prasad Guntur Ramkumar, Mark Hamilton, Mark Harbinson, Thomas Hartley, Benjamin Hudson, Nikhil Joshi, Michael Kay, Andrew Kelion, Azhar Khokhar, Jamie Kitt, Ken Lee, Chen Low, Sze Mun Mak, Ntouskou Marousa, Jon Martin, Elisa Mcalindon, Leon Menezes, Gareth Morgan-Hughes, Alastair Moss, Anthony Murray, Edward Nicol, Dilip Patel, Charles Peebles, Francesca Pugliese, Jonathan Carl Luis Rodrigues, Christopher Rofe, Nikant Sabharwal, Rebecca Schofield, Thomas Semple, Naveen Sharma, Peter Strouhal, Deepak Subedi, William Topping, Katharine Tweed, Jonathan Weir-Mccall, Suhny Abbara, Taimur Abbasi, Brian Abbott, Shady Abohashem, Sandra Abramson, Tarek Al-Abboud, Mouaz Al-Mallah, Omar Almousalli, Karthikeyan Ananthasubramaniam, Mohan Ashok Kumar, Jeffrey Askew, Lea Attanasio, Mallory Balmer-Swain, Richard R. Bayer, Adam Bernheim, Sabha Bhatti, Erik Bieging, Ron Blankstein, Stephen Bloom, Sean Blue, David Bluemke, Andressa Borges, Kelley Branch, Paco Bravo, Jessica Brothers, Matthew Budoff, Renée Bullock-Palmer, Angela Burandt, Floyd W. Burke, Kelvin Bush, Candace Candela, Elizabeth Capasso, Joao Cavalcante, Donald Chang, Saurav Chatterjee, Yiannis Chatzizisis, Michael Cheezum, Tiffany Chen, Jennifer Chen, Marcus Chen, James Clarcq, Ayreen Cordero, Matthew Crim, Sorin Danciu, Bruce Decter, Nimish Dhruva, Neil Doherty, Rami Doukky, Anjori Dunbar, William Duvall, Rachael Edwards, Kerry Esquitin, Husam Farah, Emilio Fentanes, Maros Ferencik, Daniel Fisher, Daniel Fitzpatrick, Cameron Foster, Tony Fuisz, Michael Gannon, Lori Gastner, Myron Gerson, Brian Ghoshhajra, Alan Goldberg, Brian Goldner, Jorge Gonzalez, Rosco Gore, Sandra Gracia-López, Fadi Hage, Agha Haider, Sofia Haider, Yasmin Hamirani, Karen Hassen, Mallory Hatfield, Carolyn Hawkins, Katie Hawthorne, Nicholas Heath, Robert Hendel, Phillip Hernandez, Gregory Hill, Stephen Horgan, Jeff Huffman, Lynne Hurwitz, Ami Iskandrian, Rajesh Janardhanan, Christine Jellis, Scott Jerome, Dinesh Kalra, Summanther Kaviratne, Fernando Kay, Faith Kelly, Omar Khalique, Mona Kinkhabwala, George Kinzfogl Iii, Jacqueline Kircher, Rachael Kirkbride, Michael Kontos, Anupama Kottam, Joseph Krepp, Jay Layer, Steven H. Lee, Jeffrey Leppo, John Lesser, Steve Leung, Howard Lewin, Diana Litmanovich, Yiyan Liu, Kathleen Magurany, Jeremy Markowitz, Amanda Marn, Stephen E. Matis, Michael Mckenna, Tony Mcrae, Fernando Mendoza, Michael Merhige, David Min, Chanan Moffitt, Karen Moncher, Warren Moore, Shamil Morayati, Michael Morris, Mahmud Mossa-Basha, Zorana Mrsic, Venkatesh Murthy, Prashant Nagpal, Kyle Napier, Katarina Nelson, Prabhjot Nijjar, Medhat Osman, Edward Passen, Amit Patel, Pravin Patil, Ryan Paul, Lawrence Phillips, Venkateshwar Polsani, Rajaram Poludasu, Brian Pomerantz, Thomas Porter, Ryan Prentice, Amit Pursnani, Mark Rabbat, Suresh Ramamurti, Florence Rich, Hiram Rivera Luna, Austin Robinson, Kim Robles, Cesar Rodríguez, Mark Rorie, John Rumberger, Raymond Russell, Philip Sabra, Diego Sadler, Mary Schemmer, U. Joseph Schoepf, Samir Shah, Nishant Shah, Sujata Shanbhag, Gaurav Sharma, Steven Shayani, Jamshid Shirani, Pushpa Shivaram, Steven Sigman, Mitch Simon, Ahmad Slim, David Smith, Alexandra Smith, Prem Soman, Aditya Sood, Monvadi Barbara Srichai-Parsia, James Streeter, Albert T, Ahmed Tawakol, Dustin Thomas, Randall Thompson, Tara Torbet, Desiree Trinidad, Shawn Ullery, Samuel Unzek, Seth Uretsky, Srikanth Vallurupalli, Vikas Verma, Alfonso Waller, Ellen Wang, Parker Ward, Gaby Weissman, George Wesbey, Kelly White, David Winchester, David Wolinsky, Sandra Yost, Michael Zgaljardic, Omar Alonso, Mario Beretta, Rodolfo Ferrando, Miguel Kapitan, Fernando Mut, Omoa Djuraev, Gulnora Rozikhodjaeva, Ha Le Ngoc, Son Hong Mai, and Xuan Canh Nguyen

Subjects
cardiac testing, cardiovascular disease, coronavirus, COVID-19, global health, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

Published
2021
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16. First in-human quantitative plaque characterization with ultra-high resolution coronary photon-counting CT angiography

Author

Victor Mergen, Matthias Eberhard, Robert Manka, André Euler, and Hatem Alkadhi

Subjects
coronary computed tomographic angiography (CCTA), coronary artery disease, high risk plaque, ultra-high-resolution CT, photon-counting detector CT (PCD-CT), Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

PurposeTo assess the effect of ultra-high-resolution coronary CT angiography (CCTA) with photon-counting detector (PCD) CT on quantitative coronary plaque characterization.Materials and methodsIn this IRB-approved study, 22 plaques of 20 patients (7 women; mean age 77 ± 8 years, mean body mass index 26.1 ± 3.6 kg/m2) undergoing electrocardiography (ECG)-gated ultra-high-resolution CCTA with PCD-CT were included. Images were reconstructed with a smooth (Bv40) and a sharp (Bv64) vascular kernel, with quantum iterative reconstruction (strength level 4), and using a slice thickness of 0.6, 0.4, and 0.2 mm, respectively (field-of-view 200 mm × 200 mm, matrix size 512 × 512 pixels). Reconstructions with the Bv40 kernel and slice thickness of 0.6 mm served as the reference standard. After identification of a plaque in coronary arteries with a vessel diameter ≥2 mm, plaque composition was determined using a dedicated, semi-automated plaque quantification software. Total plaque, calcified, fibrotic, and lipid-rich plaque components were quantified in all datasets.ResultsMedian plaque volume was highest (23.5 mm3, interquartiles 17.9–34.3 mm3) for reconstructions with the reference standard and lowest for ultra-high-resolution reconstructions with a slice thickness of 0.2 mm and the Bv64 kernel (18.1 mm3, interquartiles 14.1–25.8 mm3, p < 0.001). Reconstructions with the reference standard showed largest calcified (85.1%, interquartiles 76.4–91.1%) and smallest lipid-rich plaque components (0.5%, interquartiles 0.0–1.5%). Smallest calcified plaque components (75.2%, interquartiles 69.9–80.8%) and largest lipid-rich components (6.7%, interquartiles 5.1–8.4%) were found for ultra-high-resolution reconstructions with a slice thickness of 0.2 mm and the Bv64 kernel. At an identical slice thickness, volume of calcified components was always lower, and volume of lipid-rich components was always higher for reconstructions with the Bv64 kernel compared with reconstructions with the Bv40 kernel (all, p < 0.001).ConclusionThis patient study indicates significant differences of ultra-high-resolution scanning with PCD-CT on quantitative coronary plaque characterization. Reduced blooming artifacts may allow improved visualization of fibrotic and lipid-rich plaque components with the ultra-high-resolution mode of PCD-CT.

Published
2022
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17. Long-Term Monitoring of Cardiac Involvement under Migalastat Treatment Using Magnetic Resonance Tomography in Fabry Disease

Author

Constantin Gatterer, Dietrich Beitzke, Senta Graf, Max Lenz, Gere Sunder-Plassmann, Christopher Mann, Markus Ponleitner, Robert Manka, Daniel Fritschi, Pierre-Alexandre Krayenbuehl, Philipp Kamm, Olivier Dormond, Frédéric Barbey, Pierre Monney, and Albina Nowak

Subjects
Fabry disease, cardiac imaging, cardiac magnetic resonance, chaperone, migalastat, cardiomyopathy, Science
Abstract

Background: Fabry cardiomyopathy is characterized by left ventricular hypertrophy, myocardial fibrosis, arrhythmia, and premature death. Treatment with migalastat, an oral pharmacological chaperone, was associated with a stabilization of cardiac biomarkers and a reduction in left ventricular mass index, as measured by echocardiography. A recent study, using cardiac magnetic resonance (CMR) as the gold standard, found a stable course of myocardial involvement after 18 months of treatment with migalastat. Our study aimed to provide long-term CMR data for the treatment with migalastat. Methods: A total of 11 females and four males with pathogenic amenable GLA mutations were treated with migalastat and underwent 1.5T CMR imaging for routine treatment effect monitoring. The main outcome was a long-term myocardial structural change, reflected by CMR. Results: After migalastat treatment initiation, left ventricular mass index, end diastolic volume, interventricular septal thickness, posterior wall thickness, estimated glomerular filtration rate, and plasma lyso-Gb3 remained stable during the median follow-up time of 34 months (min.: 25; max.: 47). The T1 relaxation times, reflecting glycosphingolipid accumulation and subsequent processes up to fibrosis, fluctuated over the time without a clear trend. No new onset of late gadolinium enhancement (LGE) areas, reflecting local fibrosis or scar formation of the myocardium, could be detected. However, patients with initially present LGE showed an increase in LGE as a percentage of left ventricular mass. The median α-galactosidase A enzymatic activity increased from 37.3% (IQR 5.88–89.3) to 105% (IQR 37.2–177) of the lower limit of the respective reference level (p = 0.005). Conclusion: Our study confirms an overall stable course of LVMi in patients with FD, treated with migalastat. However, individual patients may experience disease progression, especially those who present with fibrosis of the myocardium already at the time of therapy initiation. Thus, a regular treatment re-evaluation including CMR is needed to provide the optimal management for each patient.

Published
2023
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19. Prognostic value of texture analysis from cardiac magnetic resonance imaging in patients with Takotsubo syndrome: a machine learning based proof-of-principle approach

Author

Manoj Mannil, Ken Kato, Robert Manka, Jochen von Spiczak, Benjamin Peters, Victoria L. Cammann, Christoph Kaiser, Stefan Osswald, Thanh Ha Nguyen, John D. Horowitz, Hugo A. Katus, Frank Ruschitzka, Jelena R. Ghadri, Hatem Alkadhi, and Christian Templin

Subjects
Medicine, Science
Abstract

Abstract Cardiac magnetic resonance (CMR) imaging has become an important technique for non-invasive diagnosis of takotsubo syndrome (TTS). The long-term prognostic value of CMR imaging in TTS has not been fully elucidated yet. This study sought to evaluate the prognostic value of texture analysis (TA) based on CMR images in patients with TTS using machine learning. In this multicenter study (InterTAK Registry), we investigated CMR imaging data of 58 patients (56 women, mean age 68 ± 12 years) with TTS. CMR imaging was performed in the acute to subacute phase (median time after symptom onset 4 days) of TTS. TA of the left ventricle was performed using free-hand regions-of-interest in short axis late gadolinium-enhanced and on T2-weighted (T2w) images. A total of 608 TA features adding the parameters age, gender, and body mass index were included. Dimension reduction was performed removing TA features with poor intra-class correlation coefficients (ICC ≤ 0.6) and those being redundant (correlation matrix with Pearson correlation coefficient r > 0.8). Five common machine-learning classifiers (artificial neural network Multilayer Perceptron, decision tree J48, NaïveBayes, RandomForest, and Sequential Minimal Optimization) with tenfold cross-validation were applied to assess 5-year outcome including major adverse cardiac and cerebrovascular events (MACCE). Dimension reduction yielded 10 TA features carrying prognostic information, which were all based on T2w images. The NaïveBayes machine learning classifier showed overall best performance with a sensitivity of 82.9% (confidence interval (CI) 80–86.2), specificity of 83.7% (CI 75.7–92), and an area-under-the receiver operating characteristics curve of 0.88 (CI 0.83–0.92). This proof-of-principle study is the first to identify unique T2w-derived TA features that predict long-term outcome in patients with TTS. These features might serve as imaging prognostic biomarkers in TTS patients.

Published
2020
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20. Postprocedural Troponin Elevation and Mortality After Transcatheter Aortic Valve Implantation

Author

Matthias Schindler, Florin Stöckli, Rico Brütsch, Philipp Jakob, Erik Holy, Jonathan Michel, Robert Manka, Paul Vogt, Christian Templin, Markus Kasel, Frank Ruschitzka, and Barbara E. Stähli

Subjects
aortic stenosis, myocardial infarction, risk stratification, transcatheter aortic valve implantation, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background This study sought to investigate the role of postprocedural troponin elevations in mortality prediction after transcatheter aortic valve implantation and to define the threshold at which clinically relevant postprocedure myocardial injury determines mortality. Methods and Results A total of 1333 consecutive patients with transcatheter aortic valve implantation with available postprocedural high‐sensitivity cardiac troponin T measurements were included in the analysis. The threshold at which postprocedure myocardial injury determines long‐term mortality was identified using restricted cubic spline analysis. A >18.3‐fold increase of troponin above the upper reference limit was identified as threshold for relevant postprocedure myocardial injury. Associations remained significant in a landmark analysis between 30 days and 2 years (hazard ratio [HR], 1.61, [95% CI, 1.13–2.28]; P=0.01), after adjusting for known confounders (adjusted HR, 1.90 [95% CI, 1.40–2.57]; P

Published
2021
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21. Management of transthyretin amyloidosis

Author

Adalgisa Condoluci, Marie Théaudin, Rahel Schwotzer, Aju P. Pazhenkottil, Paolo Arosio, Manuela Averaimo, Ulrike Bacher, Peter Bode, Andrea Cavalli, Stefan Dirnhofer, Nadia Djerbi, Stephan Dobner, Thomas Fehr, Maura Garofalo, Ariana Gaspert, Sabine Gerull, Raphael Heimgartner, Annemarie Hübers, Hans H. Jung, Chiara Kessler, Raphael Knöpfel, Natallia Laptseva, Giulia Magini, Robert Manka, Luca Mazzucchelli, Martin Meyer, Violeta Mihaylova, Pierre Monney, Alessio Mylonas, René Nkoulou, Thomas Pabst, Otmar Pfister, Axel Rüfer, Adrian Schmidt, Harald Seeger, Simon F. Stämpfli, Guido Stirnimann, Thomas Suter, Giorgio Treglia, Alexandar Tzankov, Friederike Vetter, Markus Zweier, Andreas J. Flammer, and Bernhard Gerber

Subjects
Medicine
Abstract

This article was corrected and republished online on November 4, 2021. Please see Erratum (Swiss Med Wkly. 2021;151:w30104)

Published
2021
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22. Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging

Author

Alexander Gotschy, Constantin von Deuster, Robbert J. H. van Gorkum, Mareike Gastl, Ella Vintschger, Rahel Schwotzer, Andreas J. Flammer, Robert Manka, Christian T. Stoeck, and Sebastian Kozerke

Subjects
Cardiovascular magnetic resonance imaging, Diffusion tensor imaging, Cardiac amyloidosis, Myocardial microstructure, Tissue characterization, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background In-vivo cardiovascular magnetic resonance (CMR) diffusion tensor imaging (DTI) allows imaging of alterations of cardiac fiber architecture in diseased hearts. Cardiac amyloidosis (CA) causes myocardial infiltration of misfolded proteins with unknown consequences for myocardial microstructure. This study applied CMR DTI in CA to assess microstructural alterations and their consequences for myocardial function compared to healthy controls. Methods Ten patients with CA (8 AL, 2 ATTR) and ten healthy controls were studied using a diffusion-weighed second-order motion-compensated spin-echo sequence at 1.5 T. Additionally, left ventricular morphology, ejection fraction, strain and native T1 values were obtained in all subjects. In CA patients, T1 mapping was repeated after the administration of gadolinium for extracellular volume fraction (ECV) calculation. CMR DTI analysis was performed to yield the scalar diffusion metrics mean diffusivity (MD) and fractional anisotropy (FA) as well as the characteristics of myofiber orientation including helix, transverse and E2A sheet angle (HA, TA, E2A). Results MD and FA were found to be significantly different between CA patients and healthy controls (MD 1.77 ± 0.17 10− 3 vs 1.41 ± 0.07 10− 3 mm2/s, p

Published
2019
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24. Cholinergic and dopaminergic effects on prediction error and uncertainty responses during sensory associative learning

Author

Sandra Iglesias, Lars Kasper, Samuel J. Harrison, Robert Manka, Christoph Mathys, and Klaas E. Stephan

Subjects
Acetylcholine, Dopamine, Biperiden, Amisulpride, Basal forebrain, Ventral tegmental area, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Navigating the physical world requires learning probabilistic associations between sensory events and their change in time (volatility). Bayesian accounts of this learning process rest on hierarchical prediction errors (PEs) that are weighted by estimates of uncertainty (or its inverse, precision). In a previous fMRI study we found that low-level precision-weighted PEs about visual outcomes (that update beliefs about associations) activated the putative dopaminergic midbrain; by contrast, precision-weighted PEs about cue-outcome associations (that update beliefs about volatility) activated the cholinergic basal forebrain. These findings suggested selective dopaminergic and cholinergic influences on precision-weighted PEs at different hierarchical levels.Here, we tested this hypothesis, repeating our fMRI study under pharmacological manipulations in healthy participants. Specifically, we performed two pharmacological fMRI studies with a between-subject double-blind placebo-controlled design: study 1 used antagonists of dopaminergic (amisulpride) and muscarinic (biperiden) receptors, study 2 used enhancing drugs of dopaminergic (levodopa) and cholinergic (galantamine) modulation.Pooled across all pharmacological conditions of study 1 and study 2, respectively, we found that low-level precision-weighted PEs activated the midbrain and high-level precision-weighted PEs the basal forebrain as in our previous study. However, we found pharmacological effects on brain activity associated with these computational quantities only when splitting the precision-weighted PEs into their PE and precision components: in a brainstem region putatively containing cholinergic (pedunculopontine and laterodorsal tegmental) nuclei, biperiden (compared to placebo) enhanced low-level PE responses and attenuated high-level PE activity, while amisulpride reduced high-level PE responses. Additionally, in the putative dopaminergic midbrain, galantamine compared to placebo enhanced low-level PE responses (in a body-weight dependent manner) and amisulpride enhanced high-level precision activity. Task behaviour was not affected by any of the drugs.These results do not support our hypothesis of a clear-cut dichotomy between different hierarchical inference levels and neurotransmitter systems, but suggest a more complex interaction between these neuromodulatory systems and hierarchical Bayesian quantities. However, our present results may have been affected by confounds inherent to pharmacological fMRI. We discuss these confounds and outline improved experimental tests for the future.

Published
2021
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25. Expert recommendation from the Swiss Amyloidosis Network (SAN) for systemic AL-amyloidosis

Author

Rahel Schwotzer, Andreas J. Flammer, Sabine Gerull, Thomas Pabst, Paolo Arosio, Manuela Averaimo, Ulrike Bacher, Peter Bode, Andrea Cavalli, Adalgisa Condoluci, Stefan Dirnhofer, Nadia Djerbi, Stephan W. Dobner, Thomas Fehr, Maura Garofalo, Ariana Gaspert, Raphael Heimgartner, Annemarie Hübers, Hans H. Jung, Chiara Kessler, Raphael Knöpfel, Natallia Laptseva, Robert Manka, Luca Mazzucchelli, Martin Meyer, Violeta Mihaylova, Pierre Monney, Alessio Mylonas, René Nkoulou, Aju P. Pazhenkottil, Otmar Pfister, Axel Rüfer, Adrian Schmidt, Harald Seeger, Simon F. Stämpfli, Guido Stirnimann, Thomas Suter, Marie Théaudin, Giorgio Treglia, Alexandar Tzankov, Friederike Vetter, Markus Zweier, and Bernhard Gerber

Subjects
AL amyloidosis, Swiss Amyloidosis Network, expert recommendation, diagnostic work-up and treatment, Medicine
Abstract

Systemic amyloidosis is a heterogeneous group of diseases associated with protein misfolding into insoluble beta-sheet rich structures that deposit extracellularly in different organs, eventually compromising their function. There are more than 30 different proteins, known to be amyloidogenic with “light chain” (AL)-amyloidosis being the most common type, followed by transthyretin (ATTR)-, and amyloid protein A (AA)-amyloidosis. Systemic amyloidosis is a rare disease with an incidence of around 10 patients in 1 million inhabitants. Recently several new therapeutic options have been developed for subgroups of amyloidosis patients, and the introduction of novel therapies for plasma cell myeloma has led to an increase in the therapeutic armamentarium for plasma cell disorders, including AL amyloidosis. Among them, proteasome inhibitors, immunomodulatory agents (-imids), and monoclonal antibodies have been successfully introduced into clinical practice. Still, high-quality data from randomised controlled trials regarding the benefit of these cost-intensive drugs in AL amyloidosis are widely lacking, and due to the rarity of the disease many physicians will not gain routine experience in the management of these frail patients. The diagnosis of AL amyloidosis relies on a close collaboration between clinicians, pathologists, imaging experts, and sometimes geneticists. Diagnosis and treatment options in this complex disorder should be discussed in dedicated multidisciplinary boards. In January 2020, the first meeting of the Swiss Amyloidosis Network took place in Zurich, Switzerland. One aim of this meeting was to establish a consensus guideline regarding the diagnostic work-up and the treatment recommendations for systemic amyloidosis tailored to the Swiss health care system. Forty-five participants from different fields in medicine discussed many aspects of amyloidosis. These are the Swiss Amyloidosis Network recommendations which focus on diagnostic work-up and treatment of AL-amyloidosis.

Published
2020
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26. Cardiovascular magnetic resonance T2* mapping for the assessment of cardiovascular events in hypertrophic cardiomyopathy

Author

Robert Manka, Mareike Gastl, Hatem Alkadhi, Christiane Gruner, Karin Labucay, Alexander Gotschy, Jochen Von Spiczak, Malgorzata Polacin, Florian Boenner, Malte Kelm, Frank Ruschitzka, and Sebastian Kozerke

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundHypertrophic cardiomyopathy (HCM) is associated with an increased risk of adverse cardiac events. Beyond classic risk factors, relative myocardial ischaemia and succeeding myocardial alterations, which can be detected using either contrast agents or parametric mapping in cardiovascular magnetic resonance (CMR) imaging, have shown an impact on outcome in HCM. CMR may help to risk stratify using parametric T2* mapping. Therefore, the aim of the present study was to evaluate the association of T2* values or fibrosis with cardiovascular events in HCM.MethodsThe relationship between T2* with supraventricular, ventricular arrhythmia or heart failure was retrospectively assessed in 91 patients with HCM referred for CMR on a 1.5T MR imaging system. Fibrosis as a reference was added to the model. Patients were subdivided into groups according to T2* value quartiles.Results47 patients experienced an event of ventricular arrhythmia, 25 of atrial fibrillation/flutter and 17 of heart failure. T2*≤28.7 ms yielded no association with ventricular events in the whole HCM cohort. T2* of non-obstructive HCM showed a significant association with ventricular events in univariate analysis, but not in multivariate analysis. For the combined endpoint of arrhythmic events, there was already an association for the whole HCM cohort, but again only in univariate analyses. Fibrosis stayed the strongest predictor in all analyses. There was no association for T2* and fibrosis with heart failure.ConclusionsDecreased T2* values by CMR only provide a small association with arrhythmic events in HCM, especially in non-obstructive HCM. No information is added for heart failure.

Published
2020
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27. Cardiovascular magnetic resonance T2* mapping for structural alterations in hypertrophic cardiomyopathy

Author

Mareike Gastl, Alexander Gotschy, Jochen von Spiczak, Malgorzata Polacin, Florian Bönner, Christiane Gruner, Malte Kelm, Frank Ruschitzka, Hatem Alkadhi, Sebastian Kozerke, and Robert Manka

Subjects
Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

Purpose: Hypertrophic cardiomyopathy (HCM) is characterized by a heterogeneous morphology and variable prognosis. A mismatch between left ventricular mass (LVM) and microvascular circulation with corresponding relative ischemia has been implicated to cause myocardial replacement fibrosis that deteriorates prognosis. Besides parametric T1 mapping, Cardiovascular Magnetic Resonance (CMR) T2* mapping is able to identify ischemia as well as fibrosis in cardiac and extracardiac diseases. Therefore, we aimed to investigate the value of T2* mapping to characterize structural alterations in patients with HCM. Methods: CMR was performed on a 1.5 T MR imaging system (Achieva, Philips, Best, Netherlands) using a 5-channel coil in patients with HCM (n = 103, 50.6 ± 16.4 years) and in age- and gender-matched controls (n = 20, 44.8 ± 16.9 years). T2* mapping (1 midventricular short axis slice) was acquired in addition to late gadolinium enhancement (LGE). T2* values were compared between patients with HCM and controls as well as between HCM patients with- and without fibrosis. Results: HCM patients showed significantly decreased T2* values compared to controls (26.2 ± 4.6 vs. 31.3 ± 4.3 ms, p

Published
2019
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28. Myocardial triglycerides in cardiac amyloidosis assessed by proton cardiovascular magnetic resonance spectroscopy

Author

Mareike Gastl, Sophie M. Peereboom, Alexander Gotschy, Maximilian Fuetterer, Constantin von Deuster, Florian Boenner, Malte Kelm, Rahel Schwotzer, Andreas J. Flammer, Robert Manka, and Sebastian Kozerke

Subjects
Cardiac amyloidosis, Cardiovascular magnetic resonance, Proton spectroscopy, Myocardial metabolism, Left-ventricular thickening, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Cardiac involvement of amyloidosis leads to left-ventricular (LV) wall thickening with progressive heart failure requiring rehospitalization. Cardiovascular magnetic resonance (CMR) is a valuable tool to non-invasively assess myocardial thickening as well as structural changes. Proton CMR spectroscopy (1H-CMRS) additionally allows assessing metabolites including triglycerides (TG) and total creatine (CR). However, opposing results exist regarding utilization of these metabolites in LV hypertrophy or thickening. Therefore, the aim of this study was to measure metabolic alterations using 1H-CMRS in a group of patients with thickened myocardium caused by cardiac amyloidosis. Methods 1H-CMRS was performed on a 1.5 T system (Achieva, Philips Healthcare, Best, The Netherlands) using a 5-channel receive coil in 11 patients with cardiac amyloidosis (60.5 ± 11.4 years, 8 males) and 11 age- and gender-matched controls (63.2 ± 8.9 years, 8 males). After cardiac morphology and function assessment, proton spectra from the interventricular septum (IVS) were acquired using a double-triggered PRESS sequence. Post-processing was performed using a customized reconstruction pipeline based on ReconFrame (GyroTools LLC, Zurich, Switzerland). Spectra were fitted in jMRUI/AMARES and the ratios of triglyceride-to-water (TG/W) and total creatine-to-water (CR/W) were calculated. Results Besides an increased LV mass and a thickened IVS concomitant to the disease characteristics, patients with cardiac amyloidosis presented with decreased global longitudinal (GLS) and circumferential (GCS) strain. LV ejection fraction was preserved relative to controls (60.0 ± 13.2 vs. 66.1 ± 4.3%, p = 0.17). Myocardial TG/W ratios were significantly decreased compared to controls (0.53 ± 0.23 vs. 0.80 ± 0.26%, p = 0.015). CR/W ratios did not show a difference between both groups, but a higher standard deviation in patients with cardiac amyloidosis was observed. Pearson correlation revealed a negative association between elevated LV mass and TG/W (R = − 0.59, p = 0.004) as well as GCS (R = − 0.48, p = 0.025). Conclusions A decrease in myocardial TG/W can be detected in patients with cardiac amyloidosis alongside impaired cardiac function with an association to the degree of myocardial thickening. Accordingly, 1H-CMRS may provide an additional diagnostic tool to gauge progression of cardiac amyloidosis along with standard imaging sequences. Trial registration EK 2013–0132.

Published
2019
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29. Chest pain CT in the emergency department: Watch out for the myocardium

Author

Kai Higashigaito, Ricarda Hinzpeter, Stephan Baumueller, David Benz, Robert Manka, Dagmar I. Keller, Hatem Alkadhi, and Fabian Morsbach

Subjects
Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

Rationale and Objectives: To evaluate the frequency and relevance of hypodense myocardium (HM) encountered in patients undergoing chest-pain CT in the emergency department (ED). Material and Methods: In this IRB-approved retrospective study, ECG-gated chest-pain CT examinations of 300 consecutive patients (mean age 60 ± 17 years) presenting with acute chest-pain to our ED were evaluated. Once ST-segment elevation infarction was excluded, chest-pain CT including the coronary arteries (rule-out acute coronary syndrome (ACS), pulmonary embolism (PE) and acute aortic syndrome (AAS): chest-pain CTcoronary, n = 121) or not including the coronary arteries was performed (rule-out PE and AAS: chest-pain CTw/o coronary, n = 179). Each myocardial segment was assessed for the presence of HM; attenuation was measured and compared to normal myocardium. Results: HM was identified in 27/300 patients (9%): 12/179 in chest-pain CTw/o coronary (7%) and 15/121 in chest-pain CTcoronary (12%). Mean attenuation of HM (40 ± 17 HU) was significantly lower than that of healthy myocardium (103 ± 18 HU, p

Published
2018
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30. Coronary Calcium Scoring with First Generation Dual-Source Photon-Counting CT—First Evidence from Phantom and In-Vivo Scans

Author

Matthias Eberhard, Victor Mergen, Kai Higashigaito, Thomas Allmendinger, Robert Manka, Thomas Flohr, Bernhard Schmidt, Andre Euler, and Hatem Alkadhi

Subjects
agatston score, computed tomography, coronary CT angiography, coronary calcium scoring, photon counting computed tomography, virtual monoenergetic imaging, Medicine (General), R5-920
Abstract

We evaluated the accuracy of coronary artery calcium (CAC) scoring on a dual-source photon-counting detector CT (PCD-CT). An anthropomorphic chest phantom underwent ECG-gated sequential scanning on a PCD-CT at 120 kV with four radiation dose levels (CTDIvol, 2.0–8.6 mGy). Polychromatic images at 120 kV (T3D) and virtual monoenergetic images (VMI), from 60 to 75 keV without quantum iterative reconstruction (no QIR) and QIR strength levels 1–4, were reconstructed. For reference, the same phantom was scanned on a conventional energy-integrating detector CT (120 kV; filtered back projection) at identical radiation doses. CAC scoring in 20 patients with PCD-CT (120 kV; no QIR and QIR 1–4) were included. In the phantom, there were no differences between CAC scores of different radiation doses (all, p > 0.05). Images with 70 keV, no QIR (CAC score, 649); 65 keV, QIR 3 (656); 65 keV; QIR4 (648) and T3D, QIR4 (656) showed a p < 0.001) and for each 5 keV-increase (all, p < 0.001). Patient data (median CAC score: 86 [inter-quartile range: 38–978] at 70 keV) confirmed relationships and differences between reconstructions from the phantom. First phantom and in-vivo experience with a clinical dual-source PCD-CT system shows accurate CAC scoring with VMI reconstructions at different radiation dose levels.

Published
2021
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31. Systematic use of cardiac magnetic resonance imaging in MINOCA led to a five-fold increase in the detection rate of myocarditis: a retrospective study

Author

Bettina Heidecker, Gianni Ruedi, Nora Baltensperger, Eva Gresser, Jan Kottwitz, Jan Berg, Robert Manka, Ulf Landmesser, Thomas F. Lüscher, and Dimitri Patriki

Subjects
cardiac magnetic resonance imaging, CMR-based work-up, myocarditis, Medicine
Abstract

BACKGROUND Systematic work-up of patients with myocardial infarction and non-obstructive coronary artery disease (MINOCA) using cardiac magnetic resonance imaging (CMR) led to a more than six-fold increase in the detection rate of myocarditis. In this study, we expanded on our prior two-year analysis by including preceding and subsequent years. METHODS We performed a retrospective chart review of patients with angina-like symptoms and elevated high-sensitivity troponin T (TnT-hs ≥14 ng/l) but without significant coronary artery disease, from 2011 to 2017. Patients underwent CMR to test for myocarditis. From 2011 to 2015, only patients with elevated TnT-hs, no significant coronary artery disease and moderate to high clinical likelihood of suffering from myocarditis, underwent CMR. In 2016 and 2017, CMR images were obtained from all patients with MINOCA, independent of the clinical likelihood that patients were suffering from myocarditis. RESULTS A total of 556 patients who underwent CMR (70.5% male, 57 ± 17 years, with an average left ventricular ejection fraction of 51 ± 15%) qualified for inclusion in this study’s analysis. From 2011 to 2015, 240 CMR examinations were performed, with the number increasing to 316 between 2016 and 2017. In total, myocarditis was diagnosed in 76 out of the 556 patients (13.7%). Between 2011 and 2015, the detection rate of myocarditis was 12.7 per 100,000 hospitalisations and increased 4.9-fold (p

Published
2019
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32. Non-steroidal anti-inflammatory drug use in acute myopericarditis: 12-month clinical follow-up

Author

Jan Berg, Marina Lovrinovic, Nora Baltensperger, Christine K Kissel, Jan Kottwitz, Robert Manka, Dimitri Patriki, Frank Scherff, Christian Schmied, Ulf Landmesser, Thomas F Lüscher, and Bettina Heidecker

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Objective Clinical data on the effect of non-steroidal anti-inflammatory drugs (NSAIDs) in myopericarditis are limited. Since NSAIDs are standard therapy in pericarditis, we retrospectively investigated their safety in myopericarditis.Methods In a retrospective case-control study, we identified 60 patients with myopericarditis from September 2010 to August 2017. Diagnosis was based on clinical criteria, elevated high-sensitivity troponin T and cardiac magnetic resonance imaging (CMR). All patients received standard heart failure therapy if indicated. Twenty-nine patients (62%) received NSAIDs (acetylsalicylic acid: n=7, average daily dose =1300 mg or ibuprofen: n=22, average daily dose =1500 mg) for an average duration of 4 weeks. To create two cohorts with similar baseline conditions, 15 patients were excluded. Three months after diagnosis, 29 patients were re-evaluated by CMR to measure late gadolinium enhancement (LGE).Results Baseline characteristics of those treated with or without NSAIDs were similar. Mean age was 34 (±13) years, 6 (13%) were women. Mean left ventricular ejection fraction (LVEF) was 56% (±5). 82 % of the patients (14 of 17) treated with NSAIDs experienced a decrease in LGE at 3 months, while it was only 58 % (7 of 12) of those without NSAIDs (p=0.15). At 12-month follow-up, one of the patients treated without NSAIDs experienced polymorphic ventricular tachycardia (VT) with cardiac arrest, while one of the patients with NSAIDs experienced non-sustained VT.Conclusions This is the first case-control study demonstrating that NSAIDs are safe in patients with myopericarditis and preserved LVEF. Our data suggest that this drug class should be tested prospectively in a large randomised clinical trial.

Published
2019
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33. Biventricular Arrhythmogenic Cardiomyopathy Associated with a Novel Heterozygous

Author

Tolga, Çimen, Verena C, Wilzeck, Giulia, Montrasio, Nicole R, Bonetti, Argelia, Medeiros-Domingo, Christian, Grebmer, Christian M, Matter, Felix C, Tanner, Robert, Manka, Corinna B, Brunckhorst, Firat, Duru, and Ardan M, Saguner

Abstract

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a hereditary condition that can cause sudden cardiac death in young, frequently athletic individuals under the age of 35 due to malignant arrhythmias. Competitive and endurance exercise may hasten the onset and progression of ARVC, leading to right ventricular dysfunction and potentially fatal ventricular arrhythmias earlier in life. In this article, we present a novel, pathogenic, early truncating heterozygous variant in the

Published
2022

34. Incremental Prognostic Value of Coronary Artery Calcium Score for Predicting All-Cause Mortality after Transcatheter Aortic Valve Replacement

Author

André Euler, Robert Manka, N Kuzo, Amadea L N Schönenberger, Barbara E. Stähli, Hatem Alkadhi, Matthias Eberhard, Kelly Reeve, Ricarda Hinzpeter, Felix C. Tanner, Albert Markus Kasel, University of Zurich, and Eberhard, Matthias

Subjects
Male, medicine.medical_specialty, Transcatheter aortic, medicine.medical_treatment, 610 Medicine & health, Severity of Illness Index, Transcatheter Aortic Valve Replacement, Postoperative Complications, Valve replacement, Interquartile range, Internal medicine, medicine, Humans, 2741 Radiology, Nuclear Medicine and Imaging, Radiology, Nuclear Medicine and imaging, Prospective Studies, Registries, Vascular Calcification, Aged, 80 and over, business.industry, Proportional hazards model, Coronary artery calcium score, Hazard ratio, Prognosis, Coronary revascularization, Treatment Outcome, 10209 Clinic for Cardiology, Cardiology, Female, business, Switzerland, All cause mortality
Abstract

Background Current risk models show limited performances for predicting all-cause mortality after transcatheter aortic valve replacement (TAVR). Purpose To determine the prognostic value of coronary artery calcium (CAC) scoring for predicting 30-day and 1-year mortality in patients undergoing TAVR. Materials and Methods In this single-center institutional review board-approved secondary analysis of prospectively collected data (SwissTAVI Registry), the authors evaluated participants who, before TAVR, underwent CT that included a nonenhanced electrocardiography-gated cardiac scan between May 2008 and September 2019 and who had not undergone previous coronary revascularization. Clinical data, including the European System for Cardiac Operative Risk Evaluation (EuroSCORE II), were recorded. The CAC score was determined, and 30-day and 1-year all-cause mortality were assessed by using Cox regression analyses. Results In total, 309 participants (mean age ± standard deviation, 81 years ± 7; 175 women) were included, with a median CAC score of 334 (interquartile range, 104-987). Seventy-seven of the 309 participants (25%) had a CAC score greater than or equal to 1000. A CAC score of 1000 or greater served as an independent predictor of 30-day (hazard ratio [HR], 4.5 [95% CI: 1.5, 13.6] compared with a CAC score

Published
2021
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35. Routine early postoperative computed tomography angiography after coronary artery bypass surgery: clinical value and management implications

Author

Tobias Gloor, Robert Manka, Matthias Eberhard, Mihály Károlyi, Martin O Schmiady, Vedran Savic, Paul R. Vogt, Hatem Alkadhi, Malgorzata Polacin, André Plass, and University of Zurich

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Computed Tomography Angiography, Pleural effusion, 610 Medicine & health, Coronary Angiography, Coronary artery bypass surgery, medicine, Humans, Coronary Artery Bypass, Thrombus, Vascular Patency, Aged, Computed tomography angiography, medicine.diagnostic_test, 10042 Clinic for Diagnostic and Interventional Radiology, business.industry, Graft Occlusion, Vascular, General Medicine, medicine.disease, 10020 Clinic for Cardiac Surgery, Pulmonary embolism, Surgery, Stenosis, medicine.anatomical_structure, Pneumothorax, 10209 Clinic for Cardiology, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Artery
Abstract

OBJECTIVES Computed tomography angiography (CTA) is broadly used for long-term follow-up of graft patency after coronary artery bypass graft surgery (CABG). However, its clinical value in the early postoperative setting has not been established yet. We evaluated the benefit of adding CTA to the routine clinical work-up after CABG on patient management. METHODS A total of 305 consecutive patients (269 males, median age 68 years) underwent CABG and postoperative CTA with a median of 6 days after surgery. Graft patency and additional imaging findings were assessed and their influence on diagnosis and clinical management was evaluated. RESULTS Graft occlusion or high-grade stenosis was found in 15% of the patients. Additional findings were reported in 44% of the patients, including pericardial (2%) and pleural effusion (27%), large pneumothorax (11%), pulmonary infection (4%), cardiac or vascular thrombus (2%), pulmonary embolism (2%), sternal dehiscence (1%) and additional incidental findings requiring follow-up (6%). CT findings initiated new diagnostic and/or therapeutic measures in 15% of the patients, 47% of those with diseased grafts and 19% of patients with non-graft-related findings. No adverse events related to CTA were documented. CONCLUSIONS Early routine postoperative assessment of CABG with CTA reveals both cardiac and non-cardiac findings with a high frequency, affecting clinical management in a substantial proportion of patients.

Published
2021
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36. Accuracy of dynamic three-dimensional magnetic resonance perfusion imaging for the detection of coronary artery disease in patients with reduced ejection fraction

Author

Alexander Gotschy, Cosima Jahnke, Sven Plein, Sandra Hamada, Rolf Gebker, Frank Ruschitzka, Nikolaus Marx, Malgorzata Polacin, Sebastian Kozerke, Thomas F. Lüscher, Michael Frick, Hatem Alkadhi, Robert Manka, Sabrina Oebel, Ingo Paetsch, Jochen von Spiczak, and Frank Enseleit

Subjects
medicine.medical_specialty, Ejection fraction, Radiological and Ultrasound Technology, business.industry, Medicine (miscellaneous), 030204 cardiovascular system & hematology, medicine.disease, 3. Good health, 030218 nuclear medicine & medical imaging, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Cardiac magnetic resonance perfusion imaging, Heart failure, Late gadolinium enhancement, Magnetic resonance perfusion imaging, Internal medicine, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, In patient, business
Abstract

BackgroundTo assess the accuracy of 3D cardiovascular magnetic resonance (CMR) perfusion imaging for the detection of coronary artery disease (CAD) against fractional flow reserve (FFR) and quantitative coronary angiography (QCA) in patients with reduced ejection fraction (EF).MethodsOut of 447 patients who underwent 3D CMR perfusion imaging (at 1.5 and 3.0 T under adenosine stress and at rest) at 5 European centers, 86 cases with an EF ≤50% were identified (mean age 64 ± 11 yrs, 80% male). Significant CAD was defined as a FFR value 50%. 86 individuals matched for age, gender and major cardiovascular risk factors, were chosen as the control group.ResultsThe prevalence of CAD defined by FFR (50%), P = 0.4). In relation to FFR, 3D perfusion imaging yielded a sensitivity of 84.5% (95% CI 76.0–90.4) and specificity of 77.3% (95% CI 66.7–85.3). The sensitivity of perfusion imaging was higher in patients with an EF≤50% (90.2 vs. 78.3%, P = 0.1) whereas specificity showed the reverse (62.9 vs. 90.0%, P = 0.005) The diagnostic accuracy was comparable in both subgroups (AUC 79.1 vs. 83.7%, P = 0.25). According to QCA, the prevalence of CAD was 78 vs. 72% (P = 0.4). Perfusion imaging yielded a sensitivity and specificity of 82.1 vs. 62.9%, P = 0.01 and 79.0 vs. 95.8%, P = 0.09 respectively with a high diagnostic accuracy in both subgroups (AUC 82.0 vs. 80.5%).Conclusion3D-CMR perfusion imaging yields a high sensitivity and diagnostic accuracy with regards to the detection of significant CAD irrespective of left ventricular (LV) systolic function.

Published
2021
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37. Segmental strain analysis for the detection of chronic ischemic scars in non-contrast cardiac MRI cine images

Author

Alexander Gotschy, Bettina Baessler, Matthias Eberhard, Hatem Alkadhi, Mihály Károlyi, Sebastian Kozerke, Malgorzata Polacin, Robert Manka, and University of Zurich

Subjects
Adult, Male, Science, Cardiology, Myocardial Ischemia, Scars, Magnetic Resonance Imaging, Cine, Strain (injury), 610 Medicine & health, 030204 cardiovascular system & hematology, Article, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Cicatrix, 0302 clinical medicine, Text mining, Medical research, Cardiac magnetic resonance imaging, Medicine, Humans, Myocardial infarction, cardiovascular diseases, Aged, Multidisciplinary, Ejection fraction, medicine.diagnostic_test, business.industry, 10042 Clinic for Diagnostic and Interventional Radiology, Gold standard (test), Middle Aged, medicine.disease, Magnetic Resonance Imaging, 10209 Clinic for Cardiology, cardiovascular system, Female, medicine.symptom, business, Nuclear medicine, Radial stress
Abstract

Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) is considered the gold standard for scar detection after myocardial infarction. In times of increasing skepticism about gadolinium depositions in brain tissue and contraindications of gadolinium administration in some patient groups, tissue strain-based techniques for detecting ischemic scars should be further developed as part of clinical protocols. Therefore, the objective of the present work was to investigate whether segmental strain is noticeably affected in chronic infarcts and thus can be potentially used for infarct detection based on routinely acquired non-contrast cine images in patients with known coronary artery disease (CAD). Forty-six patients with known CAD and chronic scars in LGE images (5 female, mean age 52 ± 19 years) and 24 gender- and age-matched controls with normal cardiac MRI (2 female, mean age 47 ± 13 years) were retrospectively enrolled. Global (global peak circumferential [GPCS], global peak longitudinal [GPLS], global peak radial strain [GPRS]) and segmental (segmental peak circumferential [SPCS], segmental peak longitudinal [SPLS], segmental peak radial strain [SPRS]) strain parameters were calculated from standard non-contrast balanced SSFP cine sequences using commercially available software (Segment CMR, Medviso, Sweden). Visual wall motion assessment of short axis cine images as well as segmental circumferential strain calculations (endo-/epicardially contoured short axis cine and resulting polar plot strain map) of every patient and control were presented in random order to two independent blinded readers, which should localize potentially infarcted segments in those datasets blinded to LGE images and patient information. Global strain values were impaired in patients compared to controls (GPCS p = 0.02; GPLS p = 0.04; GPRS p = 0.01). Patients with preserved ejection fraction showed also impeded GPCS compared to healthy individuals (p = 0.04). In patients, mean SPCS was significantly impaired in subendocardially (− 5.4% ± 2) and in transmurally infarcted segments (− 1.2% ± 3) compared to remote myocardium (− 12.9% ± 3, p = 0.02 and 0.03, respectively). ROC analysis revealed an optimal cut-off value for SPCS for discriminating infarcted from remote myocardium of − 7.2% with a sensitivity of 89.4% and specificity of 85.7%. Mean SPRS was impeded in transmurally infarcted segments (15.9% ± 6) compared to SPRS of remote myocardium (31.4% ± 5; p = 0.02). The optimal cut-off value for SPRS for discriminating scar tissue from remote myocardium was 16.6% with a sensitivity of 83.3% and specificity of 76.5%. 80.3% of all in LGE infarcted segments (118/147) were correctly localized in segmental circumferential strain calculations based on non-contrast cine images compared to 53.7% (79/147) of infarcted segments detected by visual wall motion assessment (p > 0.01). Global strain parameters are impaired in patients with chronic infarcts compared to controls. Mean SPCS and SPRS in scar tissue is impeded compared to remote myocardium in infarcts patients. Blinded to LGE images, two readers correctly localized 80% of infarcted segments in segmental circumferential strain calculations based on non-contrast cine images, in contrast to only 54% of infarcted segments detected due to wall motion abnormalities in visual wall motion assessment. Analysis of segmental circumferential strain shows a promising method for detection of chronic scars in routinely acquired, non-contrast cine images for patients who cannot receive or decline gadolinium., Scientific Reports, 11 (1), ISSN:2045-2322

Published
2021

38. Mid- to long-term cardiac magnetic resonance findings in elite athletes recovered from COVID-19 - results from one German Olympic medical center

Author

Christopher Schneeweis, Katharina Diebold, Thomas Schramm, Christine Syrek, Hans-Georg Predel, Robert Manka, and Jonas Zacher

Abstract

Background There is a lack of cardiac magnetic resonance (CMR) data regarding mid- to long-term myocardial damage due to Covid-19 in elite athletes. Objective This study investigated mid-to long-term consequences of myocardial involvement after a Covid-19 infection in elite athletes. Methods Between January 2020 and October 2021, 27 athletes of the German Olympic centre Rhineland with confirmed Covid-19 infection were analyzed. 9 healthy non-athlete volunteers served as control. CMR was performed in mean 182 days (SD 99) after initial positive test result. Results CMR did not reveal any signs of acute myocarditis in regard to the current Lake Louise criteria or myocardial damage in any of the 26 elite athletes with previous Covid-19 infection. Nevertheless, 92 % of the athletes experienced a symptomatic course and 54 % reported lasting symptoms for more than 4 weeks. In one male athlete CMR revealed an arrhythmogenic right ventricular cardiomyopathy (ARVC) and this athlete was excluded from the study. Athletes had significantly enlarged left and right ventricle volumes and increased left ventricular myocardial mass in comparison to the healthy control group (LVEDVi 103.4 vs. 91.1 ml/m 2 p=0.031; RVEDVi 104.1 vs. 86.6 ml/m 2 p=0.007; and LVMi 59.0 vs. 46.2 g/m 2 p=0.002). Conclusion Our findings suggest that the risk for mid-to long-term myocardial damage seems to be very low to negligible in elite athletes. No conclusions can be drawn regarding myocardial injury in the acute phase of infection nor about possible long-term myocardial effects in the general population.

Published
2022
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39. Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

Author

Andrew J. Einstein, Cole Hirschfeld, Michelle C. Williams, Joao V. Vitola, Nathan Better, Todd C. Villines, Rodrigo Cerci, Leslee J. Shaw, Andrew D. Choi, Sharmila Dorbala, Ganesan Karthikeyan, Bin Lu, Valentin Sinitsyn, Alexey A. Ansheles, Takashi Kudo, Chiara Bucciarelli-Ducci, Bjarne Linde Nørgaard, Pál Maurovich-Horvat, Roxana Campisi, Elisa Milan, Lizette Louw, Adel H. Allam, Mona Bhatia, Lorenzo Sewanan, Eli Malkovskiy, Yosef Cohen, Michael Randazzo, Jagat Narula, Olga Morozova, Thomas N.B. Pascual, Yaroslav Pynda, Maurizio Dondi, Diana Paez, Gerd Hinterleitner, Yao Lu, Zhuoran Xu, Cole B. Hirschfeld, Ikenna Erinne, Mrinali Shetty, Andrew Choi, Juan Lopez-Mattei, Purvi Parwani, Artan Goda, Ervina Shirka, Salah Bouyoucef, Lydia Chelghoum, Farouk Mansouri, Abdelkader Medjahedi, Qais Naili, Mokhtar Ridouh, Diego Alasia, Lucia Alberghina, Natalia Aramayo, Diego Buchara, Franco Gabriel Busso, Jose Javier Bustos Rivadero, Jorge Camilletti, Hugo Campanelli, Ricardo Belisario Castro, Mariana Daicz, Horacio del Riego, Laura Dragonetti, Diego Echazarreta, Juan Erriest, Fernando Faccio, Adolfo Facello, Hugo Gallegos, Ricardo Geronazzo, Horacio Glait, Victor Hasbani, Victor Jäger, Julio Manuel Lewkowicz, Jose Lotti, Neiva Maciel, Osvaldo Masoli, Edgardo Mastrovito, Maria Medus, Maria Fernanda Merani, Susana Molteni, Marcos Montecinos, Gustavo Parisi, Claudio Pereyra Sueldo, Diego Perez de Arenaza, Luis Quintana, Alejandro Radzinschi, Marcela Redruello, Marina Rodríguez, Horacio Rojas, Arturo Romero Acuña, Daniel Schere, Sonia Traverso, Gustavo Vazquez, Susana Zeffiro, Mari Sakanyan, Scott Beuzeville, Raef Boktor, Michael Crowley, D'Arne Downie, Girish Dwivedi, Barry Elison, Omar Farouque, Kim Jasper, Subodh Joshi, Joseph Lee, Kenneth Lee, Elaine Lui, Peter Mcconachie, Joanne Meaker, Dee Nandurkar, Johanne Neill, Edward O'Rourke, Patricia O'Sullivan, George Pandos, Manuja Premaratne, David Prior, Natalie Rutherford, Connor Saunders, Kim Taubman, Andrew Tauro, Andrew Taylor, James Theuerle, Paul Thomas, Jonathan Tow, Anthony Upton, Shankar Vamadevan, Victor Wayne, Eva Alina Wegner, David Wong, John Younger, Dietrich Beitzke, Gudrun Feuchtner, Oliver Sommer, Konrad Weiss, Natallia Maroz-Vadalazhskaya, Uladzimir Tserakhau, Filip Homans, Caroline M. Van De Heyning, Raúl Araujo, Valentina Soldat-Stankovic, Sinisa Stankovic, Augusto Almeida, Carlos Anselmi, Guilherme S.A. Azevedo, Marcio Sommer Bittencourt, Diego Bromfman Pianta, Estevan Cabeda, Lara Carreira, Igor Coelho, Fernando de Amorim Fernandes, Andrea de Lorenzo, Roberta Delgado, Fernanda Erthal, Fabio Fernandes, Juliano Fernandes, Thiago Ferreira de Souza, Murilo Foppa, Wilson Furlan Matos Alves, Cibele Gontijo, Ilan Gottlieb, Gabriel Grossman, Maria Helena Albernaz Siqueira, Cesar Higa Nomura, Katia Hiromoto Koga, Ronaldo Lima, Rafael Lopes, Hugo Humberto Marçal Filho, Paulo Masiero, Luiz Mastrocola, Maria Eduarda Menezes de Siqueira, Claudio Mesquita, Danilo Naves, Filipe Penna, Ibraim Pinto, Thércio Rocha, Juliana Leal Rocha, Alfredo Rodrigues, Leila Salioni, Adelina Sanches, Marcelo Santos, Leonardo Sara Da Silva, Paulo Schvartzman, Cristina Sebastião Matushita, Tiago Senra, Marcelo Silva, Carlos Eduardo Soares, Bernardo Spiro, Carlos Eduardo Suaide Silva, Rafael Torres, Guilherme Urpia Monte, Andrea Vilela, Alexandre Volney Villa, Joao Vitola, Themissa Voss, Roberto Waltrick, Marcello Zapparoli, Hamid Naseer, Marina Garcheva-Tsacheva, Tiémégna Florence Ouattara, Sarameth Thou, Soley Varoeun, Gad Abikhzer, Rob Beanlands, Michael Chetrit, Dominique Dabreo, Carole Dennie, Matthias Friedrich, Mohmmed Nassoh Hafez, Kate Hanneman, Robert Miller, Anastasia Oikonomou, Idan Roifman, Gary Small, Vikas Tandon, Adwait Trivedi, James White, Katherine Zukotynski, Rita Alay, Carmen Concha, Teresa Massardo, Pedro Abad, Kelly Anzola, Harold Arturo, Luis Benitez, Alberto Cadena, Carlos Caicedo Zamudio, Antonio Calderón, Claudia T. Gutierrez Villamil, Claudia Jaimes, Juan L. Londono, Nelson Lopez, Sonia Merlano-Gaitan, Ramon Murgieitio-Cabrera, Manuel Valencia, Damiana Vergel, Alejandro Zuluaga Santamaria, Felix Solis, Tonci Batinic, Maja Franceschi, Maja Hrabak Paar, Marina Prpic, Cuba: Juan Felipe Batista, Lazaro Omar Cabrera, Amalia Peix, Yamilé Peña, Luis Manuel Rochela Vázquez, Ioannis Ntalas, Milan Kaminek, Vladimir Kincl, Otto Lang, Jawdat Abdulla, Morten Bøttcher, Martin Busk, Uka Geisler, Lars C. Gormsen, Nicolaj Hansson, Søren Hess, Jens Hove, Lars Thorbjoern Jensen, Magnus T. Jensen, Kristian Hay Kragholm, Bjarne L. Nørgaard, Kristian Øvrehus, Jan Rasmussen, Niels Peter Rønnow Sand, Hanne Sondergaard, Tomas Zaremba, Herwin Speckter, Nelson Amores, Mayra Sanchez Velez, Taghreed Abd Alrahman, Sherif Abd Elsamad, Alia Abdelfattah, Adel Allam, Sameh Elkaffas, Mona Hassan, Elshaymaa Hussein, Ahmed Ibrahim, Ahmed Kandeel, Mohamed Mandour Ali, Mahmoud Shaaban, Camila Flores, Verónica Vanesa Gómez Leiva, Anita Liiver, Martti Larikka, Valtteri Uusitalo, Denis Agostini, Clothilde Berger, Matthieu Dietz, Fabien Hyafil, Mickaël Ohana, Kevin Prigent, Hamza Regaieg, Laure Sarda-Mantel, Darach O. H-Ici, Harold Ayetey, George Angelidis, Christina Fragkaki, Chrysoula Fragkiadaki, Panagiotis Georgoulias, Maria Koutelou, Elena Kyrozi, Niki Lama, Vassilis Prassopoulos, Michael Spartalis, Theodora Zaglavara, Carla Gonzalez, Goleat Gutierrez, Alejandro Maldonado, Yassine Martinez, Attila Kovács, Bálint Szilveszter, Nilesh Banthia, Vivek Bhat, Partha Choudhury, Vijay Sai Chowdekar, Johann Christopher, Tushar Garg, Naresh Kumar Goyal, Ripen Kumar Gupta, Abhishek Gupta, Julie Hephzibah, Shashank Jain, Jesu Krupa, Parveen Kumar, Sukriti Kumar, Arati Lalchandani, Animesh Mishra, Vivaswan Dutt Mishra, Parul Mohan, Ahmad Ozair, Shivani Pandey, Ramanathapuram Parameswaran, Chetan Patel, Tapan Patel, Shivani Patel, Leena Robinson Vimala, Dr Pradosh Kumar Sarangi, Shantanu Sengupta, Arvind Sethi, Amit Sharma, Awadhesh Kumar Sharma, Punit Sharma, Apurva Shrigiriwar, Santosh Singh, Harpreet Singh, Ashwani Sood, Atul Verma, Ajay Vyas, Erwin Affandi Soeriadi, Edison Bun, Febby Hutomo, Hilman Syawaluddin, Ryan Yudistiro, Amjed Albadr, Majid Assadi, Farshad Emami, Alireza Emami-Ardekani, Saeed Farzanehfar, Ramezan Jafari, Reyhaneh Manafi-Farid, Maryam Tajik, Yoav Arnson, Shmuel Fuchs, Ronen Goldkorn, John Kennedy, Marina Leitman, Aryeh Shalev, Wanda Acampa, Domenico Albano, Pierpaolo Alongi, Gaspare Arnone, Roberta Assante, Anna Baritussio, Matteo Bauckneht, Francesco Bianco, Rachele Bonfiglioli, Francesco Bovenzi, Isabella Bruno, Andrea Bruno, Elena Busnardo, Elena Califaretti, Roberta Casoni, Vittorio Censullo, Franca Chierichetti, Marcello Chiocchi, Corrado Cittanti, Alberto Clemente, Alberto Cuocolo, Maria Luisa De Rimini, Giuseppe De Vincentis, Veronica Della Tommasina, Santo Dellegrottaglie, Paola Anna Erba, Laura Evangelista, Lara Faggi, Evelina Faragasso, Luigia Florimonte, Viviana Frantellizzi, Marco Gatti, Angela Gaudiano, Fabrizia Gelardi, Alberto Gerali, Alessia Gimelli, Marco Guglielmo, Lucia Leccisotti, Riccardo Liga, Carlo Liguori, Giampiero Longo, Margherita Maffione, Claudio Marcassa, Giovanni Matassa, Donato Mele, Luca Mircoli, Andrea Paccagnella, Sara Pacella, Federica Padovano, Dario Pellegrini, Valeria Pergola, Luca Pugliese, Natale Quartuccio, Lucia Rampin, Fabrizio Ricci, Giuseppe Rubini, Vincenzo Russo, Gianmario Sambuceti, Alessandra Scatteia, Roberto Sciagrà, Gianluca Spidalieri, Antonella Stefanelli, Carlo Tedeschi, Guido Ventroni, Dainia Baugh, Ernest Madu, Tadao Aikawa, Hiroshi Asano, Shinichiro Fujimoto, Koichiro Fujise, Yoshimitsu Fukushima, Kae Fukuyama, Yasutaka Ichikawa, Reiko Ideguchi, Nobuo Iguchi, Masamichi Imai, Hayato Ishimura, Satoshi Isobe, Kimiteru Ito, Yu Izawa, Toshiaki Kadokami, Tokuo Kasai, Takao Kato, Takashi Kawamoto, Shigeru Kiryu, Shinichiro Kumita, Osamu Manabe, Hirotaka Maruno, Naoya Matsumoto, Masao Miyagawa, Masao Moroi, Shigeki Nagamachi, Kenichi Nakajima, Ryo Nakazato, Mamoru Nanasato, Masanao Naya, Takashi Norikane, Yasutoshi Ohta, Yoichi Otomi, Hideki Otsuka, Noriko Oyama-Manabe, Masaki Saito, Masayoshi Sarai, Junichi Sato, Daisuke Sato, Shinya Shiraishi, Kentaro Takanami, Kazuya Takehana, Yasuyo Taniguchi, Hiroki Teragawa, Nobuo Tomizawa, Kyoko Umeji, Yasushi Wakabayashi, Shinichiro Yamada, Shinya Yamazaki, Tatsuya Yoneyama, Mohammad Rawashdeh, Tairkhan Dautov, Khalid Makhdomi, Mostafa Abass, Masoud Garashi, Qaisar Siraj, Marika Kalnina, Mohamad Haidar, Renata Komiagiene, Giedre Kviecinskiene, Donatas Vajauskas, Noor Khairiah A. Karim, Mady Doucoure, Luise Reichmuth, Anthony Samuel, Mohamed Lemine Dieng, Ambedhkar Shantaram Naojee, Estrella Aguilera Hernandez, Cesar Rene Alducin Tellez, Erick Alexánderson-Rosas, Erika Barragan, Manuel Cabada, Daniel Calderón, Isabel Carvajal-Juarez, José Esparza, Manlio Gerardo Gama-Moreno, Virginia Garcia Quinto, Nelsy Coromoto Gonzalez, Mary Carmen Herrera-Zarza, Aloha Meave, Jesus Gregorio Medina Verdugo, Gabriela Melendez, Rafael Humberto Morales Murguia, Carlos Salvador Navarro Quiroz, Mario Ornelas, Andres Preciado-Anaya, Oscar Ulises Preciado-Gutiérrez, Adriana Puente, Aristóteles Ramírez Salazar, Sandra Graciela Rosales Uvera, Sandra Rosales-Uvera, Jose Antonio Serna Macias, Lilia Sierra-Galan, Lilia M. Sierra-Galan, Juan Carlos Tirado Alderete, Enrique Vallejo, Marc Faraggi, Erdenechimeg Sereegotov, Nouzha Ben Rais, Nadia Ismaili Alaoui, Thiri Kyiphyu, Su Thet Oo, Soe Myat Win, Htin Zar, Ram Ghimire, Madhu Neupane, Andor Glaudemans, Riemer Slart, Derk Verschure, Berry Allen, John Edmond, Clare Mckenzie, Stuart Tie, Niels Van Pelt, Kirsten Worthington, Calum Young, Idrissa Adamou Soli, Shehu Kana, Uchenna Onubogu, Mahmoud Sani, Anders Tjellaug Bråten, Arve Jørgensen, Hanne-Elin Vassbotn, Humoud Al Dhuhli, Zabah Jawa, Naima Tag, Shazia Fatima, Muhammad Babar Imran, Muhammad Numair Younis, Mohammad Saadullah, Yariela Herrera Malo, Dora Lenturut-Katal, Manuel Castillo, José Ortellado, Afroza Akhter, F. Aaysha Cader, Raihan Hussain, Saidur Rahman Khan, Tapati Mandal, Faria Nasreen, Yunqiang An, Dianbo Cao, Lianggeng Gong, Yang Hou, Chongfu Jia, Tao Li, Caiying Li, Hui Liu, Wenya Liu, Jinkang Liu, Ming-Yen Ng, Heshui Shi, Chunxiang Tang, Ximing Wang, Zhaoqian Wang, Yining Wang, Jiang Wu, Yan Yi, Li Yuan, Tong Zhang, Longjiang Zhang, Edith Chavez, Carlos Cruz, Christian Llontop, Rosanna Morales, Paz Abrihan, Asela Bustos-Barroso, Michele Duldulao-Ogbac, Christopher Eduarte, Jerry Obaldo, Alvin Quinon, Belinda San Juan, Carlo Joe San Juan, Marie Rhiamar Sauler-Gomez, Mila Uy, Magdalena Kostkiewicz, Jolanta Kunikowska, Anna Teresinska, Tomasz Urbanik, Nuno Bettencourt, Ricardo Fontes-Carvalho, Cristina Gavina, Lino Gonçalves, Filipe Macedo, Nuno Moreno, Carla Sousa, Ana Teresa Timoteo, Maria João Vidigal, Mahmoud Al Heidous, Subramaniyan Ramanathan, Samer Arnous, Said Aytani, Angela Byrne, Tadhg Gleeson, David Kerins, Julie O'Brien, Ji-In Bang, Henry Bom, Miju Cheon, Gi Jeong Cheon, Sang-Geon Cho, Chae Moon Hong, Yong Hyu Jeong, Won Jun Kang, Yeon-Koo Kang, Ji-Young Kim, So Won Oh, Young So, Ho-Chun Song, Kyoung Sook Won, Soo Woong Yoo, Irena Mitevska, Marija Vavlukis, Barbara Gužic Salobir, Monika Štalc, Theodora Benedek, Marian Pop, Claudiu Stan, Alexey Ansheles, Olga Dariy, Nina Gagarina, Irina Itskovich, Anatoliy Karalkin, Alexander Kokov, Gulya Marina, Ekaterina Migunova, Viktor Pospelov, Daria Ryzhkova, Guzaliya Sayfullina, Vladimir Sergienko, Irina Shurupova, Margarita Vakhromeeva, Nailia Valiullina, Konstantin Zavadovsky, Kirill Zhuravlev, Rami Abazid, Turki Al Garni, Mirvat Alasnag, Ahmed Aljizeeri, Hamid Amer, Ahmad Amro, Hesham Hamdy, Osama Smettei, Dragana Sobic Saranovic, Marina Vlajkovic, Felix Keng, Jason See, Zuzana Berecova, Jana Polakova Mistinova, Osayande Evbuomwan, Nerisha Govender, Jonathan Hack, Bawinile Hadebe, Khanyisile Hlongwa, Mitchell Kaplan, Hoosen Lakhi, Katarina Milos, Moshe Modiselle, Stuart More, Ntanganedzeni Muambadzi, Leonie Scholtz, Manuel Barreiro-Perez, Isabel Blanco, Jordi Broncano, Alicia Camarero, Irene Casáns-Tormo, Javier De Haro, Albert Flotats, Elia García, Ceferino Gutierrez Mendiguchia, Amelia Jimenez-Heffernan, Ruben Leta, Javier Lopez Diaz, Luis Lumbreras Vega, Ana Manovel-Sánchez, Amparo Martinez Monzonis, Bianca Patrut, Virginia Pubul, Ricardo Ruano Perez, Nahla Zeidan, Damayanthi Nanayakkara, Ahmed Suliman, Henrik Engblom, Mustafa Murtadha, Ellen Ostenfeld, Magnus Simonsson, Hatem Alkadhi, Ronny Ralf Buechel, Peter Burger, Christoph Gräni, Christel Kamani, Nadine Kawel-Böhm, Bernd Klaeser, Robert Manka, John Prior, Tawika Kaewchur, Benjapa Khiewvan, Arpakorn Kositwattanarerk, Sirianong Namwongprom, Tanyaluck Thientunyakit, Haluk Burcak Sayman, Mahmut Yüksel, Mugisha Julius Sebikali, Emmy Okello, Pavlo Korol, Iryna Noverko, Maryna Satyr, Tahir Ahmad, Khaled Alfakih, Ivo Andrade, Susan Buckingham, Anda Bularga, John-Paul Carpenter, Graham Cole, David Cusack, Sarojini David, Patrick Davis, Timothy Fairbairn, Arjun Ghosh, Prasad Guntur Ramkumar, Mark Hamilton, Faisal Haque, Benjamin Hudson, Annette Johnstone, V.J. 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Zapparoli, M, Naseer, H, Garcheva-Tsacheva, M, Ouattara, T, Thou, S, Varoeun, S, Abikhzer, G, Beanlands, R, Chetrit, M, Dabreo, D, Dennie, C, Friedrich, M, Hafez, M, Hanneman, K, Miller, R, Oikonomou, A, Roifman, I, Small, G, Tandon, V, Trivedi, A, White, J, Zukotynski, K, Alay, R, Concha, C, Massardo, T, Abad, P, Anzola, K, Arturo, H, Benitez, L, Cadena, A, Zamudio, C, Calderon, A, Gutierrez Villamil, C, Jaimes, C, Londono, J, Lopez, N, Merlano-Gaitan, S, Murgieitio-Cabrera, R, Valencia, M, Vergel, D, Santamaria, A, Solis, F, Batinic, T, Franceschi, M, Paar, M, Prpic, M, Felipe Batista, C, Cabrera, L, Peix, A, Pena, Y, Rochela Vazquez, L, Ntalas, I, Kaminek, M, Kincl, V, Lang, O, Abdulla, J, Bottcher, M, Busk, M, Geisler, U, Gormsen, L, Hansson, N, Hess, S, Hove, J, Jensen, L, Jensen, M, Kragholm, K, Ovrehus, K, Rasmussen, J, Ronnow Sand, N, Sondergaard, H, Zaremba, T, Speckter, H, Amores, N, Velez, M, Alrahman, T, Elsamad, S, Abdelfattah, A, Elkaffas, S, Hassan, M, Hussein, E, Ibrahim, A, Kandeel, A, Ali, M, Shaaban, M, Flores, C, Gomez Leiva, V, Liiver, A, Larikka, M, Uusitalo, V, Agostini, D, Berger, C, Dietz, M, Hyafil, F, Ohana, M, Prigent, K, Regaieg, H, Sarda-Mantel, L, H-Ici, D, Ayetey, H, Angelidis, G, Fragkaki, C, Fragkiadaki, C, Georgoulias, P, Koutelou, M, Kyrozi, E, Lama, N, Prassopoulos, V, Spartalis, M, Zaglavara, T, Gonzalez, C, Gutierrez, G, Maldonado, A, Martinez, Y, Kovacs, A, Szilveszter, B, Banthia, N, Bhat, V, Choudhury, P, Chowdekar, V, Christopher, J, Garg, T, Goyal, N, Gupta, R, Gupta, A, Hephzibah, J, Jain, S, Krupa, J, Kumar, P, Kumar, S, Lalchandani, A, Mishra, A, Mishra, V, Mohan, P, Ozair, A, Pandey, S, Parameswaran, R, Patel, C, Patel, T, Patel, S, Vimala, L, Kumar Sarangi, D, Sengupta, S, Sethi, A, Sharma, A, Sharma, P, Shrigiriwar, A, Singh, S, Singh, H, Sood, A, Verma, A, Vyas, A, Soeriadi, E, Bun, E, Hutomo, F, Syawaluddin, H, Yudistiro, R, Albadr, A, Assadi, M, Emami, F, Emami-Ardekani, A, Farzanehfar, S, Jafari, R, Manafi-Farid, R, Tajik, M, Arnson, Y, Fuchs, S, Goldkorn, R, Kennedy, J, Leitman, M, Shalev, A, Acampa, W, Albano, D, Alongi, P, Arnone, G, Assante, R, Baritussio, A, Bauckneht, M, Bianco, F, Bonfiglioli, R, Bovenzi, F, Bruno, I, Bruno, A, Busnardo, E, Califaretti, E, Casoni, R, Censullo, V, Chierichetti, F, Chiocchi, M, Cittanti, C, Clemente, A, Cuocolo, A, De Rimini, M, De Vincentis, G, Della Tommasina, V, Dellegrottaglie, S, Erba, P, Evangelista, L, Faggi, L, Faragasso, E, Florimonte, L, Frantellizzi, V, Gatti, M, Gaudiano, A, Gelardi, F, Gerali, A, Gimelli, A, Guglielmo, M, Leccisotti, L, Liga, R, Liguori, C, Longo, G, Maffione, M, Marcassa, C, Matassa, G, Mele, D, Mircoli, L, Paccagnella, A, Pacella, S, Padovano, F, Pellegrini, D, Pergola, V, Pugliese, L, Quartuccio, N, Rampin, L, Ricci, F, Rubini, G, Russo, V, Sambuceti, G, Scatteia, A, Sciagra, R, Spidalieri, G, Stefanelli, A, Tedeschi, C, Ventroni, G, Baugh, D, Madu, E, Aikawa, T, Asano, H, Fujimoto, S, Fujise, K, Fukushima, Y, Fukuyama, K, Ichikawa, Y, Ideguchi, R, Iguchi, N, Imai, M, Ishimura, H, Isobe, S, Ito, K, Izawa, Y, Kadokami, T, Kasai, T, Kato, T, Kawamoto, T, Kiryu, S, Kumita, S, Manabe, O, Maruno, H, Matsumoto, N, Miyagawa, M, Moroi, M, Nagamachi, S, Nakajima, K, Nakazato, R, Nanasato, M, Naya, M, Norikane, T, Ohta, Y, Otomi, Y, Otsuka, H, Oyama-Manabe, N, Saito, M, Sarai, M, Sato, J, Sato, D, Shiraishi, S, Takanami, K, Takehana, K, Taniguchi, Y, Teragawa, H, Tomizawa, N, Umeji, K, Wakabayashi, Y, Yamada, S, Yamazaki, S, Yoneyama, T, Rawashdeh, M, Dautov, T, Makhdomi, K, Abass, M, Garashi, M, Siraj, Q, Kalnina, M, Haidar, M, Komiagiene, R, Kviecinskiene, G, Vajauskas, D, Karim, N, Doucoure, M, Reichmuth, L, Samuel, A, Dieng, M, Naojee, A, Hernandez, E, Alducin Tellez, C, Alexanderson-Rosas, E, Barragan, E, Cabada, M, Calderon, D, Carvajal-Juarez, I, Esparza, J, Gama-Moreno, M, Quinto, V, Gonzalez, N, Herrera-Zarza, M, Meave, A, Medina Verdugo, J, Melendez, G, Morales Murguia, R, Navarro Quiroz, C, Ornelas, M, Preciado-Anaya, A, Preciado-Gutierrez, O, Puente, A, Salazar, A, Rosales Uvera, S, Rosales-Uvera, S, Serna Macias, J, Sierra-Galan, L, Tirado Alderete, J, Vallejo, E, Faraggi, M, Sereegotov, E, Ben Rais, N, Alaoui, N, Kyiphyu, T, Oo, S, Win, S, Zar, H, Ghimire, R, Neupane, M, Glaudemans, A, Slart, R, Verschure, D, Allen, B, Edmond, J, Mckenzie, C, Tie, S, Van Pelt, N, Worthington, K, Young, C, Soli, I, Kana, S, Onubogu, U, Sani, M, Braten, A, Jorgensen, A, Vassbotn, H, Al Dhuhli, H, Jawa, Z, Tag, N, Fatima, S, Imran, M, Younis, M, Saadullah, M, Malo, Y, Lenturut-Katal, D, Castillo, M, Ortellado, J, Akhter, A, Cader, F, Hussain, R, Khan, S, Mandal, T, Nasreen, F, An, Y, Cao, D, Gong, L, Hou, Y, Jia, C, Li, T, Li, C, Liu, H, Liu, W, Liu, J, Ng, M, Shi, H, Tang, C, Wang, X, Wang, Z, Wang, Y, Wu, J, Yi, Y, Yuan, L, Zhang, T, Zhang, L, Chavez, E, Cruz, C, Llontop, C, Morales, R, Abrihan, P, Bustos-Barroso, A, Duldulao-Ogbac, M, Eduarte, C, Obaldo, J, Quinon, A, San Juan, B, San Juan, C, Sauler-Gomez, M, Uy, M, Kostkiewicz, M, Kunikowska, J, Teresinska, A, Urbanik, T, Bettencourt, N, Fontes-Carvalho, R, Gavina, C, Goncalves, L, Macedo, F, Moreno, N, Sousa, C, Timoteo, A, Vidigal, M, Al Heidous, M, Ramanathan, S, Arnous, S, Aytani, S, Byrne, A, Gleeson, T, Kerins, D, O'Brien, J, Bang, J, Bom, H, Cheon, M, Cheon, G, Cho, S, Hong, C, Jeong, Y, Kang, W, Kang, Y, Kim, J, Oh, S, So, Y, Song, H, Won, K, Yoo, S, Mitevska, I, Vavlukis, M, Salobir, B, Stalc, M, Benedek, T, Pop, M, Stan, C, Dariy, O, Gagarina, N, Itskovich, I, Karalkin, A, Kokov, A, Marina, G, Migunova, E, Pospelov, V, Ryzhkova, D, Sayfullina, G, Sergienko, V, Shurupova, I, Vakhromeeva, M, Valiullina, N, Zavadovsky, K, Zhuravlev, K, Abazid, R, Al Garni, T, Alasnag, M, Aljizeeri, A, Amer, H, Amro, A, Hamdy, H, Smettei, O, Saranovic, D, Vlajkovic, M, Keng, F, See, J, Berecova, Z, Mistinova, J, Evbuomwan, O, Govender, N, Hack, J, Hadebe, B, Hlongwa, K, Kaplan, M, Lakhi, H, Milos, K, Modiselle, M, More, S, Muambadzi, N, Scholtz, L, Barreiro-Perez, M, Blanco, I, Broncano, J, Camarero, A, Casans-Tormo, I, De Haro, J, Flotats, A, Garcia, E, Mendiguchia, C, Jimenez-Heffernan, A, Leta, R, Diaz, J, Vega, L, Manovel-Sanchez, A, Monzonis, A, Patrut, B, Pubul, V, Perez, R, Zeidan, N, Nanayakkara, D, Suliman, A, Engblom, H, Murtadha, M, Ostenfeld, E, Simonsson, M, Alkadhi, H, Buechel, R, Burger, P, Grani, C, Kamani, C, Kawel-Bohm, N, Klaeser, B, Manka, R, Prior, J, Kaewchur, T, Khiewvan, B, Kositwattanarerk, A, Namwongprom, S, Thientunyakit, T, Sayman, H, Yuksel, M, Sebikali, M, Okello, E, Korol, P, Noverko, I, Satyr, M, Ahmad, T, Alfakih, K, Andrade, I, Buckingham, S, Bularga, A, Carpenter, J, Cole, G, Cusack, D, David, S, Davis, P, Fairbairn, T, Ghosh, A, Ramkumar, P, Hamilton, M, Haque, F, Hudson, B, Johnstone, A, Karthikeyan, V, Kay, M, Khan, M, Kitt, J, Low, C, Mcalindon, E, Mccreavy, D, Morrissey, B, Motwani, M, Na, D, Nicol, E, Patel, D, Rodrigues, J, Rofe, C, Schofield, R, Semple, T, Sheikh, A, Sinha, A, Subedi, D, Topping, W, Tweed, K, Underwood, S, Weir-Mccall, J, Zuhairy, H, Abbasi, T, Abohashem, S, Abramson, S, Al-Mallah, M, Kumar, M, Balmer-Swain, M, Berman, D, Bernheim, A, Bhatti, S, Biederman, R, Bieging, E, Bingham, S, Bloom, S, Blue, S, Borges, A, Branch, K, Bravo, P, Buddhe, S, Budoff, M, Bullock-Palmer, R, Cahill, M, Candela, C, Cao, J, Chatterjee, S, Chatzizisis, Y, Chaudhuri, N, Cheezum, M, Chelliah, A, Chen, T, Chen, M, Chen, L, Chokshi, A, Chung, J, Danciu, S, Desisto, W, Dilorenzo, M, Doukky, R, Duvall, W, Ferencik, M, Foster, C, Fuisz, A, Gannon, M, German, D, Gerson, M, Geske, J, Hage, F, Haider, A, Haider, S, Hamirani, Y, Hassen, K, Hendel, R, Henkel, J, Horgan, S, Hyun, M, Janardhanan, R, Jerome, S, Kalra, D, Kassop, D, Kinkhabwala, M, Kinzfogl, G, Koch, B, Koweek, L, Krepp, J, Kwon, Y, Layer, J, Lesser, J, Leung, S, Lisske, B, Magurany, K, Markowitz, J, Mccullough, B, Moalemi, A, Moffitt, C, Montanez, J, Moore, W, Morayati, S, Mossa-Basha, M, Mrsic, Z, Murthy, V, Nagpal, P, Nelson, K, Nijjar, P, O'Quinn, R, Passen, E, Patil, P, Pursnani, A, Quachang, N, Rabbat, M, Ranjan, P, Lozano, P, Schemmer, M, Seifried, R, Shah, N, Shah, A, Shanbhag, S, Sharma, G, Skotnicki, R, Sobczak, M, Soman, P, Sorrell, V, Srichai, M, Streeter, J, Strickland, L, Suliman, S, Tebyanian, N, Thomas, D, Thompson, R, Uretsky, S, Vallurupalli, S, Vandyck-Acquah, M, Verma, V, Weinstein, J, Wolinsky, D, Zareba, K, Zgaljardic, M, Beretta, M, Ferrando, R, Kapitan, M, Mut, F, Djuraev, O, Rozikhodjaeva, G, Vera, L, Duc, B, Nguyen, X, Hiep Nguyen, P, Einstein, Andrew J, Hirschfeld, Cole, Williams, Michelle C, Vitola, Joao V, Better, Nathan, Villines, Todd C, Cerci, Rodrigo, Shaw, Leslee J, Choi, Andrew D, Dorbala, Sharmila, Karthikeyan, Ganesan, Lu, Bin, Sinitsyn, Valentin, Ansheles, Alexey A, Kudo, Takashi, Bucciarelli-Ducci, Chiara, Nørgaard, Bjarne Linde, Maurovich-Horvat, Pál, Campisi, Roxana, Milan, Elisa, Louw, Lizette, Allam, Adel H, Bhatia, Mona, Sewanan, Lorenzo, Malkovskiy, Eli, Cohen, Yosef, Randazzo, Michael, Narula, Jagat, Morozova, Olga, Pascual, Thomas N B, Pynda, Yaroslav, Dondi, Maurizio, Paez, Diana, and Cuocolo, Alberto

Subjects
cardiac testing, Health Personnel, delivery of health care, coronavirus, COVID-19, global health, 610 Medicine & health, cardiovascular disease, health personnel, humans, pandemics, surveys and questionnaires, coronaviru, Surveys and Questionnaires, Humans, Cardiology and Cardiovascular Medicine, Delivery of Health Care, Pandemics, COVID-19/epidemiology
Abstract

BACKGROUND: The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES: The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS: The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS: Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS: Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing.

Published
2022
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40. Segmental strain for scar detection in acute myocardial infarcts and in follow-up exams using non-contrast CMR cine sequences

Author

Ioannis Matziris, Hatem Alkadhi, Robert Manka, Sebastian Kozerke, Mihály Károlyi, Malgorzata Polacin, Matthias Eberhard, and University of Zurich

Subjects
Magnetic Resonance Spectroscopy, Cardiac magnetic resonance, Ischemic heart disease, media_common.quotation_subject, Acute myocardial infarction, Feature tracking, Myocardial Infarction, Magnetic Resonance Imaging, Cine, 610 Medicine & health, Ventricular Function, Left, Cicatrix, Humans, Medicine, Contrast (vision), cardiovascular diseases, Aged, Retrospective Studies, media_common, Strain (chemistry), business.industry, 10042 Clinic for Diagnostic and Interventional Radiology, Myocardium, Middle Aged, cardiovascular system, 10209 Clinic for Cardiology, Nuclear medicine, business, Cardiology and Cardiovascular Medicine, Follow-Up Studies
Abstract

Background The purpose of the study was to investigate feasibility of infarct detection in segmental strain derived from non-contrast cardiac magnetic resonance (CMR) cine sequences in patients with acute myocardial infarction (AMI) and in follow-up (FU) exams. Methods 57 patients with AMI (mean age 61 ± 12 years, CMR 2.8 ± 2 days after infarction) were retrospectively included, FU exams were available in 32 patients (35 ± 14 days after first CMR). 43 patients with normal CMR (54 ± 11 years) served as controls. Dedicated software (Segment CMR, Medviso) was used to calculate global and segmental strain derived from cine sequences. Cine short axis stacks and segmental circumferential strain calculations of every patient and control were presented to two blinded readers in random order, who were advised to identify potentially infarcted segments, blinded to LGE and clinical information. Results Impaired global strain was measured in AMI patients compared to controls (global peak circumferential strain [GPCS] p = 0.01; global peak longitudinal strain [GPLS] p = 0.04; global peak radial strain [GPRS] p = 0.01). In both imaging time points, mean segmental peak circumferential strain [SPCS] was impaired in infarcted tissue compared to remote segments (AMI: p = 0.03, FU: p = 0.02). SPCS values in infarcted segments were similar between AMI and FU (p = 0.8). In SPCS calculations, 141 from 189 acutely infarcted segments were accurately detected (74.6%), visual evaluation of correlating cine images detected 43.4% infarcts. In FU, 80% infarcted segments (91/114 segments) were detected in SPCS and 51.8% by visual evaluation of correlating short axis cine images (p = 0.01). Conclusion Segmental circumferential strain derived from routinely acquired native cine sequences detects nearly 75% of acute infarcts and 80% of infarcts in subacute follow-up CMR, significantly more than visual evaluation of correlating cine images alone. Acute infarcts may display only subtle impairment of wall motion and no obvious wall thinning, thus SPCS calculation might be helpful for scar detection in patients with acute infarcts, when LGE images are not available., BMC Cardiovasular Disorders, 22, ISSN:1471-2261

Published
2022
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41. Texture analysis of acute myocardial infarction with CT: First experience study.

Author

Ricarda Hinzpeter, Matthias W Wagner, Moritz C Wurnig, Burkhardt Seifert, Robert Manka, and Hatem Alkadhi

Subjects
Medicine, Science
Abstract

To investigate the feasibility and accuracy of texture analysis to distinguish through objective and quantitative image information between healthy and infarcted myocardium with computed tomography (CT).Twenty patients (5 females; mean age 56±10years) with proven acute myocardial infarction (MI) and 20 patients (8 females; mean age 42±15years) with no cardiac abnormalities (hereafter termed controls) underwent contrast-enhanced cardiac CT. Short axis CT images of the left ventricle (LV) were reconstructed at the slice thicknesses 1mm, 2mm, and 5mm. Two independent, blinded readers segmented the LV in controls and patients. Texture analysis was performed yielding first-level features based on the histogram (variance, skewness, kurtosis, entropy), second-level features based on the gray-level co-occurrence matrix (GLCM) (contrast, correlation, energy and homogeneity), and third-level features based on the gray-level run-length matrix (GLRLM).Inter-and intrareader agreement was good to excellent for all histogram (intraclass correlation coefficient (ICC):0.70-0.93) and for all GLCM features (ICC:0.66-0.99), and was variable for the GLRLM features (ICC:-0.12-0.99). Univariate analysis showed significant differences between patients and controls for 2/4 histogram features, 3/4 GLCM and for 6/11 GLRLM features and all assessed slice thicknesses (all,p

Published
2017
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42. International Impact of COVID-19 on the Diagnosis of Heart Disease

Author

Einstein, A. J., Shaw, L. J., Hirschfeld, C., Williams, M. C., Villines, T. C., Better, N., Vitola, J. V., Cerci, R., Dorbala, S., Raggi, P., Choi, A. D., Lu, B., Sinitsyn, V., Sergienko, V., Kudo, T., Norgaard, B. L., Maurovich-Horvat, P., Campisi, R., Milan, E., Louw, L., Allam, A. H., Bhatia, M., Malkovskiy, E., Goebel, B., Cohen, Y., Randazzo, M., Narula, J., Pascual, T. N. B., Pynda, Y., Dondi, M., Gerd Hinterleitner, Paez D., Yao, Lu, Olga, Morozova, Zhuoran, Xu, Juan, Lopez-Mattei, Purvi, Parwani, Mohammad Nawaz Nasery, Artan, Goda, Ervina, Shirka, Rabie, Benlabgaa, Salah, Bouyoucef, Abdelkader, Medjahedi, Qais, Nailli, Mariela, Agolti, Roberto Nicolas Aguero, Maria Del Carmen Alak, Lucia Graciela Alberguina, Guillermo, Arroñada, Andrea, Astesiano, Alfredo, Astesiano, Carolina Bas Norton, Pablo, Benteo, Juan, Blanco, Juan Manuel Bonelli, Jose Javier Bustos, Raul, Cabrejas, Jorge, Cachero, Alejandro, Canderoli, Silvia, Carames, Patrícia, Carrascosa, Ricardo, Castro, Oscar, Cendoya, Luciano Martin Cognigni, Carlos, Collaud, Claudia, Cortes, Javier, Courtis, Daniel, Cragnolino, Mariana, Daicz, Alejandro De La Vega, Silvia Teresa De Maria, Horacio Del Riego, Fernando, Dettori, Alejandro, Deviggiano, Laura, Dragonetti, Mario, Embon, Ruben Emilio Enriquez, Jorge, Ensinas, Fernando, Faccio, Adolfo, Facello, Diego, Garofalo, Ricardo, Geronazzo, Natalia, Gonza, Lucas, Gutierrez, Miguel Angel Guzzo, Victor, Hasbani, Melina, Huerin, Victor, Jäger, Julio Manuel Lewkowicz, Maria Nieves, A López De Munaín, Jose Maria Lotti, Alejandra, Marquez, Osvaldo, Masoli, Edgardo, Mastrovito, Matias, Mayoraz, Graciela Eva Melado, Anibal, Mele, Maria Fernanda Merani, Alejandro Horacio Meretta, Susana, Molteni, Marcos, Montecinos, Eduardo, Noguera, Carlos, Novoa, Claudio Pereyra Sueldo, Sebastian Perez Ascani, Pablo, Pollono, Maria Paula Pujol, Alejandro, Radzinschi, Gustavo, Raimondi, Marcela, Redruello, Marina, Rodríguez, Matías, Rodríguez, Romina Lorena Romero, Arturo Romero Acuña, Federico, Rovaletti, Lucas San Miguel, Lucrecia, Solari, Bruno, Strada, Sonia, Traverso, Sonia Simona Traverzo, Maria Del Huerto Velazquez Espeche, Juan Sebastian Weihmuller, Juan, Wolcan, Susana, Zeffiro, Mari, Sakanyan, Scott, Beuzeville, Raef, Boktor, Patrick, Butler, Jennifer, Calcott, Loretta, Carr, Virgil, Chan, Charles, Chao, Woon, Chong, Mark, Dobson, D'Arne, Downie, Girish, Dwivedi, Barry, Elison, Jean, Engela, Roslyn, Francis, Anand, Gaikwad, Ashok Gangasandra Basavaraj, Bruce, Goodwin, Robert, Greenough, Christian, Hamilton-Craig, Victar, Hsieh, Subodh, Joshi, Karin, Lederer, Kenneth, Lee, Joseph, Lee, John, Magnussen, Nghi, Mai, Gordon, Mander, Fiona, Murton, Dee, Nandurkar, Johanne, Neill, Edward, O'Rourke, Patricia, O'Sullivan, George, Pandos, Kunthi, Pathmaraj, Alexander, Pitman, Rohan, Poulter, Manuja, Premaratne, David, Prior, Lloyd, Ridley, Natalie, Rutherford, Hamid, Salehi, Connor, Saunders, Luke, Scarlett, Sujith, Seneviratne, Deepa, Shetty, Ganesh, Shrestha, Jonathan, Shulman, Vijay, Solanki, Tony, Stanton, Murch, Stuart, Michael, Stubbs, Ian, Swainson, Kim, Taubman, Andrew, Taylor, Paul, Thomas, Steven, Unger, Anthony, Upton, Shankar, Vamadevan, William Van Gaal, Johan, Verjans, Demetrius, Voutnis, Victor, Wayne, Peter, Wilson, David, Wong, Kirby, Wong, John, Younger, Gudrun, Feuchtner, Siroos, Mirzaei, Konrad, Weiss, Natallia, 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Matis, Michael, Mckenna, Tony, Mcrae, Fernando, Mendoza, Michael, Merhige, David, Min, Chanan, Moffitt, Karen, Moncher, Warren, Moore, Shamil, Morayati, Michael, Morris, Mahmud, Mossa-Basha, Zorana, Mrsic, Venkatesh, Murthy, Prashant, Nagpal, Kyle, Napier, Katarina, Nelson, Prabhjot, Nijjar, Medhat, Osman, Edward, Passen, Amit, Patel, Pravin, Patil, Ryan, Paul, Lawrence, Phillips, Venkateshwar, Polsani, Rajaram, Poludasu, Brian, Pomerantz, Thomas, Porter, Ryan, Prentice, Amit, Pursnani, Mark, Rabbat, Suresh, Ramamurti, Florence, Rich, Hiram Rivera Luna, Austin, Robinson, Kim, Robles, Cesar, Rodríguez, Mark, Rorie, John, Rumberger, Raymond, Russell, Philip, Sabra, Diego, Sadler, Mary, Schemmer, U Joseph Schoepf, Samir, Shah, Nishant, Shah, Sujata, Shanbhag, Gaurav, Sharma, Steven, Shayani, Jamshid, Shirani, Pushpa, Shivaram, Steven, Sigman, Mitch, Simon, Ahmad, Slim, David, Smith, Alexandra, Smith, Prem, Soman, Aditya, Sood, Monvadi Barbara Srichai-Parsia, James, Streeter, Albert, T Ahmed Tawakol, Dustin, Thomas, Randall, Thompson, Tara, Torbet, Desiree, Trinidad, Shawn, Ullery, Samuel, Unzek, Seth, Uretsky, Srikanth, Vallurupalli, Vikas, Verma, Alfonso, Waller, Ellen, Wang, Parker, Ward, Gaby, Weissman, George, Wesbey, Kelly, White, David, Winchester, David, Wolinsky, Sandra, Yost, Michael, Zgaljardic, Omar, Alonso, Mario, Beretta, Rodolfo, Ferrando, Miguel, Kapitan, Fernando, Mut, Omoa, Djuraev, Gulnora, Rozikhodjaeva, Ha Le Ngoc, Son Hong Mai, Xuan Canh Nguyen, Einstein, A. 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Subjects
INCAPS COVID Investigators Group, Heart disease, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Diagnostic Techniques, Cardiovascular, coronavirus, global health, IAEA, Disease, Telehealth, Cardiorespiratory Medicine and Haematology, 030204 cardiovascular system & hematology, Cardiovascular, 0302 clinical medicine, cardiovascular disease, cardiac testing, COVID-19, diagnostic techniques, cardiovascular, health care surveys, heart diseases, humans, international agencies, Pandemic, Global health, 030212 general & internal medicine, COVID-19 Heart Disease, Cause of death, STATEMENT, Heart Disease, International Agencie, Public Health and Health Services, Biomedical Imaging, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Heart Diseases, 03 medical and health sciences, Clinical Research, medicine, Humans, Personal protective equipment, Heart Disease - Coronary Heart Disease, business.industry, International Agencies, medicine.disease, the, coronaviru, Diagnostic Techniques, Good Health and Well Being, Clinical research, Cardiovascular System & Hematology, Health Care Survey, Health Care Surveys, Emergency medicine, Global Health, business
Abstract

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. OBJECTIVES The study sought to assess COVID-19`s impact on global cardiovascular diagnostic procedural volumes and safety practices. METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. RESULTS Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoradc echocardiography decreased by 59%, transesophageat echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). hi multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and teteheatth. CONCLUSIONS COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19-related changes in care delivery is warranted. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Published
2021
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44. A Prospective Pilot Study to Identify a Myocarditis Cohort who may Safely Resume Sports Activities 3 Months after Diagnosis

Author

Leslie T. Cooper, Thomas F Luescher, Christine K. Kissel, Frank Scherff, Bettina Heidecker, Marina Lovrinovic, Dimitri Patriki, F.C. Tanner, Christian Schmied, Jan Berg, Nora Baltensperger, Jan Kottwitz, Robert Manka, University of Zurich, and Heidecker, Bettina

Subjects
Male, 0301 basic medicine, Time Factors, 3003 Pharmaceutical Science, Pharmaceutical Science, Pilot Projects, 030204 cardiovascular system & hematology, Ventricular tachycardia, Ventricular Function, Left, Sudden cardiac death, 0302 clinical medicine, Risk Factors, Medicine, Prospective Studies, Prospective cohort study, Genetics (clinical), Aged, 80 and over, Ejection fraction, medicine.diagnostic_test, Middle Aged, Prognosis, Myocarditis, Echocardiography, Cohort, 10209 Clinic for Cardiology, cardiovascular system, Cardiology, Molecular Medicine, Female, Cardiology and Cardiovascular Medicine, Arrhythmia, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit, Adult, 2716 Genetics (clinical), medicine.medical_specialty, 610 Medicine & health, Physical exercise, Risk Assessment, 2705 Cardiology and Cardiovascular Medicine, Young Adult, 03 medical and health sciences, Magnetic resonance imaging, 1311 Genetics, Predictive Value of Tests, Cardiac magnetic resonance imaging, Internal medicine, Correspondence, Genetics, Humans, cardiovascular diseases, Exercise, Aged, business.industry, Stroke Volume, Recovery of Function, medicine.disease, Return to Sport, 030104 developmental biology, 1313 Molecular Medicine, Electrocardiography, Ambulatory, Exercise Test, business
Abstract

International cardiovascular society recommendations to return to sports activities following acute myocarditis are based on expert consensus in the absence of prospective studies. We prospectively enrolled 30 patients with newly diagnosed myocarditis based on clinical parameters, laboratory measurements and cardiac magnetic resonance imaging with mildly reduced or preserved left ventricular ejection fraction (LVEF) with a follow-up of 12 months. Cessation of physical activity was recommended for 3 months. The average age was 35 (19–80) years with 73% male patients. One case of non-sustained ventricular tachycardia was recorded during 48-h-Holter electrocardiogram. Except for this case, all patients were allowed to resume physical exercise after 3 months. At 6- (n = 26) and 12-month (n = 19) follow-up neither cardiac events nor worsening LVEF were recorded. The risk of cardiac events at 1 year after diagnosis of myocarditis appears to be low after resumption of exercise after 3 months among patients who recover from acute myocarditis.

Published
2020
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45. EACVI survey on the evaluation of infective endocarditis

Author

Nina Ajmone Marsan, Kristina H. Haugaa, Espen Holte, Antonello D'Andrea, Robert Manka, Ivan Stankovic, Marc R. Dweck, University of Zurich, and Holte, Espen

Subjects
medicine.medical_specialty, Prosthesis-Related Infections, Nuclear imaging, 610 Medicine & health, 030204 cardiovascular system & hematology, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, 0302 clinical medicine, medicine, Hospital discharge, Medical imaging, echocardiography, Humans, 2741 Radiology, Nuclear Medicine and Imaging, Endocarditis, survey, Radiology, Nuclear Medicine and imaging, Intensive care medicine, nuclear imaging, Modalities, medicine.diagnostic_test, business.industry, EACVI, Endocarditis, Bacterial, General Medicine, medicine.disease, Eacvi Survey, Europe, Positron emission tomography, Homogeneous, Heart Valve Prosthesis, Positron-Emission Tomography, Infective endocarditis, 10209 Clinic for Cardiology, Cardiology and Cardiovascular Medicine, business, CT
Abstract

Aims To evaluate the diagnosis and imaging of patients with suspected endocarditis and the management in routine clinical practice across Europe, the EACVI Scientific Initiatives Committee performed a survey across European centres. In particular, the routine use of echocardiography, advanced imaging modalities and multidisciplinary team was explored. Methods and results A total of 100 European Echocardiography Laboratories from 29 different countries responded to the survey, which consisted of 20 questions. For most of the use of echocardiography and advanced imaging, answers from the centres were relatively homogeneous and demonstrated good adherence to current recommendations. In particular, two-thirds of centres report the use of a specific endocarditis team for decision-making. Echocardiography plays a key role in the diagnosis and management of endocarditis. Nuclear imaging modalities are broadly available among the centres and are mainly used in prosthetic valve endocarditis and cardiac device-related infective endocarditis. Computed tomography (CT) is widely available and used to assess for structural valve abnormalities, neurological complications, and to preoperative assessment of the coronary arteries. Most institutions provide structured patients follow-up following hospital discharge. Conclusion In Europe, a relatively homogenous adherence to current recommendation was observed for most diagnostic and management including the follow-up of patients with endocarditis. Decision-making is most commonly performed by a multidisciplinary team. Echocardiography remains the first line and central imaging modality for patient diagnosis and assessment, but 60% of centres also commonly use CT, whilst positron emission tomography imaging is used in patients with prosthetic valve endocarditis or device infection.

Published
2020
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46. Free-breathing motion-informed locally low-rank quantitative 3D myocardial perfusion imaging

Author

Tobias Hoh, Valery Vishnevskiy, Malgorzata Polacin, Robert Manka, Maximilian Fuetterer, and Sebastian Kozerke

Subjects
Motion, Adenosine, Coronary Circulation, Respiration, Myocardial Perfusion Imaging, Humans, Radiology, Nuclear Medicine and imaging, Magnetic Resonance Imaging
Abstract

To propose respiratory motion-informed locally low-rank reconstruction (MI-LLR) for robust free-breathing single-bolus quantitative 3D myocardial perfusion CMR imaging. Simulation and in-vivo results are compared to locally low-rank (LLR) and compressed sensing reconstructions (CS) for reference.Data were acquired using a 3D Cartesian pseudo-spiral in-out k-t undersampling scheme (R = 10) and reconstructed using MI-LLR, which encompasses two stages. In the first stage, approximate displacement fields are derived from an initial LLR reconstruction to feed a motion-compensated reference system to a second reconstruction stage, which reduces the rank of the inverse problem. For comparison, data were also reconstructed with LLR and frame-by-frame CS using wavelets as sparsifying transform (Improved uniformity of MBF maps with reduced local variations was achieved with MI-LLR. For rest and stress, intra-volunteer variation of absolute and relative MBF was lower in MI-LLR (±0.17 mL/g/min [26%] and ±1.07 mL/g/min [33%]) versus LLR (±0.19 mL/g/min [28%] and ±1.22 mL/g/min [36%]) and versusThe combination of pseudo-spiral Cartesian undersampling and dual-stage MI-LLR reconstruction improves free-breathing quantitative 3D myocardial perfusion CMR imaging under rest and stress condition.

Published
2022

48. Skeletal Muscle Disorders: A Noncardiac Source of Cardiac Troponin T

Author

Jeanne du Fay de Lavallaz, Alexandra Prepoudis, Maria Janina Wendebourg, Eva Kesenheimer, Diego Kyburz, Thomas Daikeler, Philip Haaf, Julia Wanschitz, Wolfgang N. Löscher, Bettina Schreiner, Mira Katan, Hans H. Jung, Britta Maurer, Angelika Hammerer-Lercher, Agnes Mayr, Danielle M. Gualandro, Annemarie Acket, Christian Puelacher, Jasper Boeddinghaus, Thomas Nestelberger, Pedro Lopez-Ayala, Noemi Glarner, Samyut Shrestha, Robert Manka, Joanna Gawinecka, Salvatore Piscuoglio, John Gallon, Sophia Wiedemann, Michael Sinnreich, Christian Mueller, Tibor Zehntner, Raoul Giger, Thomas Stoll, Hadrien Schöpfer, Fabian Jordan, Michael Carigiet, Nicola Haeni, Vincent Gysin, Michele Sara Gafner, Desiree Wussler, Luca Koechlin, Michael Freese, Christian Ruiz, Olivia Strauch, Tobias Zimmermann, Ivo Strebel, Ulrich A. Walker, Thomas Vogt, Martina Hartmann, Timo Kahles, Paul Hasler, Funda Seidel, Xenia Zavtsyea, Katharina Rentsch, Sandra Mitrovic, Arnold von Eckardstein, Johannes Mair, Michael Schreinlechner, Wijstke Wallimann, Manuel Dietrich, Tania Carrillo Roah, Markus Knoll, Alexander Fuchs, Ellen Bruske, Matthias Munz, Stefan Kunzelmann, Gesa Albert, Tobias Becher, Peter Kastner, Samuel Katsuyuki Shinjo, University of Zurich, and Mueller, Christian

Subjects
Male, Heart Diseases, Troponin I, Reproducibility of Results, 610 Medicine & health, Middle Aged, Article, 2705 Cardiology and Cardiovascular Medicine, 10040 Clinic for Neurology, 2737 Physiology (medical), Muscular Diseases, Troponin T, Physiology (medical), Case-Control Studies, 540 Chemistry, 10209 Clinic for Cardiology, cardiovascular system, Humans, Female, Prospective Studies, RNA, Messenger, Cardiology and Cardiovascular Medicine, Biomarkers, 10038 Institute of Clinical Chemistry
Abstract

Background: Cardiac troponin (cTn) T and cTnI are considered cardiac specific and equivalent in the diagnosis of acute myocardial infarction. Previous studies suggested rare skeletal myopathies as a noncardiac source of cTnT. We aimed to confirm the reliability/cardiac specificity of cTnT in patients with various skeletal muscle disorders (SMDs). Methods: We prospectively enrolled patients presenting with muscular complaints (≥2 weeks) for elective evaluation in 4 hospitals in 2 countries. After a cardiac workup, patients were adjudicated into 3 predefined cardiac disease categories. Concentrations of cTnT/I and resulting cTnT/I mismatches were assessed with high-sensitivity (hs-) cTnT (hs-cTnT–Elecsys) and 3 hs-cTnI assays (hs-cTnI–Architect, hs-cTnI–Access, hs-cTnI–Vista) and compared with those of control subjects without SMD presenting with adjudicated noncardiac chest pain to the emergency department (n=3508; mean age, 55 years; 37% female). In patients with available skeletal muscle biopsies, TNNT/I1-3 mRNA differential gene expression was compared with biopsies obtained in control subjects without SMD. Results: Among 211 patients (mean age, 57 years; 42% female), 108 (51%) were adjudicated to having no cardiac disease, 44 (21%) to having mild disease, and 59 (28%) to having severe cardiac disease. hs-cTnT/I concentrations significantly increased from patients with no to those with mild and severe cardiac disease for all assays (all P P P TNNT2 , encoding cTnT (but none for TNNI3 , encoding cTnI) versus control subjects (n=16, P Wald R =0.59, P t-statistic R =0.26, P t-statistic =0.031). Conclusions: In patients with active chronic SMD, elevations in cTnT concentrations are common and not attributable to cardiac disease in the majority. This was not observed for cTnI and may be explained in part by re-expression of cTnT in skeletal muscle. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03660969.

Published
2022
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49. Three-dimensional Whole-Heart Cardiac MRI Sequence for Measuring Trabeculation in Left Ventricular Noncompaction

Author

Malgorzata Polacin, Mihály Károlyi, Verena Wilzeck, Matthias Eberhard, Alexander Gotschy, Hatem Alkadhi, Sebastian Kozerke, Robert Manka, University of Zurich, and Manka, Robert

Subjects
Technical Development, 10042 Clinic for Diagnostic and Interventional Radiology, 10209 Clinic for Cardiology, 2741 Radiology, Nuclear Medicine and Imaging, Radiology, Nuclear Medicine and imaging, 610 Medicine & health
Abstract

PURPOSE: To compare three-dimensional (3D) whole-heart MRI with isotropic submillimeter resolution with standard two-dimensional (2D) cine MRI in measuring the bilayered myocardium in left ventricular noncompaction (LVNC). MATERIALS AND METHODS: Twenty-four patients with LVNC (mean age, 42 years ± 16 [SD]) were retrospectively enrolled between October 2011 and July 2020. Compacted myocardium (CM) and noncompacted myocardium (NCM) were measured in long axis (Petersen approach) and short axis (Jacquier approach) at 3D whole-heart and 2D cine MRI by two independent readers. Image quality (1 = excellent, 2 = adequate, 3 = nondiagnostic), considering discrimination between NCM and CM and CM and adjacent tissue, was evaluated. Pearson, Spearman, and intraclass correlation tests were used as statistical tests. RESULTS: In long-axis measurements, the correlation between both sequences was moderate to strong for CM (Pearson, 0.66–0.79; Spearman, 0.61–0.68) and strong to very strong for NCM (Pearson, 0.90–0.97; Spearman, 0.77–0.91). Intraclass correlation coefficient (ICC) in 3D whole-heart MRI was 0.90 (95% CI: 0.78, 0.95) for CM and 0.94 (95% CI: 0.84, 0.97) for NCM, while ICC in 2D cine MRI was 0.77 (95% CI: 0.55, 0.89) for CM and 0.87 (95% CI: 0.72, 0.94) for NCM. Short-axis CM and NCM measurements had a strong to very strong correlation between both sequences (Pearson, 0.86–0.98; Spearman, 0.82–0.98). ICC in 3D whole-heart MRI was 0.96 (95% CI: 0.94, 0.99) for CM and 0.98 (95% CI: 0.97, 0.99) for NCM, while ICC in 2D cine MRI was 0.82 (95% CI: 0.63, 0.92) for CM and 0.87 (95% CI: 0.72, 0.94) for NCM. 3D whole-heart MRI demonstrated higher image quality than did 2D cine MRI (P < .001). CONCLUSION: 3D whole-heart MRI revealed higher image quality, with better structure discrimination and interobserver agreement in LVNC measurements, compared with standard 2D cine images. Keywords: MR Imaging, Cardiac, Cardiovascular Magnetic Resonance, Left Ventricular Noncompaction, Free-breathing Imaging Technique Supplemental material is available for this article. © RSNA, 2022 See also the commentary by Jensen and Petersen in this issue.

Published
2022
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50. Right ventricular involvement in left ventricular non-compaction cardiomyopathy

Author

Markus Niemann, Robert Manka, Simon F. Stämpfli, Felix C. Tanner, Pascal Kiarostami, Christiane Gruner, Alexander Gotschy, Tardu Özkartal, and University of Zurich

Subjects
medicine.medical_specialty, Short axis, Heart Ventricles, cardiac magnetic resonance imaging, Cardiomyopathy, Magnetic Resonance Imaging, Cine, 610 Medicine & health, Left Ventricular Non-Compaction Cardiomyopathy, Cardiac magnetic resonance imaging, Predictive Value of Tests, Internal medicine, medicine, Quantitative assessment, Humans, echocardiography, trabeculation, Isolated Noncompaction of the Ventricular Myocardium, medicine.diagnostic_test, business.industry, General Medicine, medicine.disease, medicine.anatomical_structure, Ventricle, left ventricular non-compaction cardiomyopathy, 10209 Clinic for Cardiology, Cardiology, Cardiology and Cardiovascular Medicine, business, Cardiac magnetic resonance, Cardiomyopathies
Abstract

Background: Left ventricular non-compaction cardiomyopathy (LVNC) features extensive trabecu-lations. Involvement of the right ventricle (RV) has been reported; however, distinction from normal RV trabeculation is difficult. This study aimed at assessing RV morphology and function in LVNC by cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE). Methods: Dimensional and functional parameters were assessed according to guidelines. Novel CMR parameters were RV end-diastolic (ED) trabeculated area, RV ED trabeculated volume, and RV ED non-compacted to compacted (NC/N) ratio in short axis (SAX) as well as in four-chamber view (4CH). Results: Twenty patients with LVNC and 20 controls were included. RV size and function were com-parable in LVNC and controls and exhibited a good correlation between TTE and CMR. Although RV trabeculated area, RV trabeculated volume, and RV ED NC/C ratio in SAX as well as in 4CH were larger in LVNC, there was a major overlap with values in controls. RV ED NC/C ratio in SAX cor-related with LV ED NC/C ratio (not in 4CH). Quantitative assessment of RV non-compaction was not feasible in TTE. Conclusions: Right ventricle size and function in LVNC can be measured by CMR and TTE, while RV trabeculation can only be quantified by CMR. RV myocardium displays more trabeculations in LVNC; however, overlap with normal individuals is extensive, not allowing separation of patients with LVNC from controls., Cardiology Journal, 29 (3)

Published
2022
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