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To retrospectively assess the correlation between pulmonary arterial obstruction index (PAOI) and right lateral ventricular wall thickness with in-hospital mortality in patients with acute pulmonary embolism. CT angiography (CTA) of 55 consecutive patients (30 males; 25 females; mean age ± SD, 59 ± 11 years) with proven acute pulmonary embolism was investigated. PAOI was determined according to the Qanadli score on CTA. Right ventricular lateral wall thickness was also measured, and patients’ in-hospital mortality was recorded. The correlation between PAOI and mortality, right ventricular lateral wall thickness and mortality, and PAOI and right ventricular lateral wall thickness was evaluated. PAOI was 23.6 and 10.4 in patients with and without in-hospital mortality, respectively (P

Background: Cardiovascular disease (CVD) is one of the leading causes of mortality in both developed and developing countries. Therefore, identification of CVD risk factors is one of the most important steps in preventing this disease. Evidence suggests that imaging of the cardiac anatomy can be helpful for risk assessment. Objectives: This study aimed to assess two cardiac anatomy features, namely, the angle between the aortic valve and the left ventricular inflow long axis (AV-LV angle) and the coronary artery calcium (CAC) score. Patients and Methods: This cross-sectional study was conducted on 74 patients with indications for computed tomography angiography (CTA) according to the American Heart Association (AHA) guidelines from July 2019 to January 2020 in Iran. The Agatston method was applied to measure the CAC score. Besides, to determine the AV-LV angle, the angle between a line tangent to the aortic valve leaflets and a line through the center of the aorta toward the left ventricular apex was measured. The patients’ baseline characteristics were also documented by conducting interviews. Results: Of 74 patients, 56% were male. The mean age of the patients was 54.41 ± 12.31 years, and their mean body mass index (BMI) was 26.71 ± 3.89 kg/m2. The frequency of smoking was 28% among the participants. A history of hypertension was reported in 38.7% of the patients, and a history of dyslipidemia was reported in 36%. Besides, the history of myocardial infarction was reported in 4% of the patients, diabetes mellitus in 9.3% of the patients, and angioplasty in 6% of the patients. The CAC score only had significant relationships with hypertension and age (correlation coefficients = 0.51). On the other hand, the AV-LV angle had no significant relationship with the patients’ baseline characteristics. The statistical analysis of the AV-LV angle and CAC score showed no significant relationship between these parameters (P = 0.756). Conclusion: The AV-LV angle and the CAC score were not significantly associated. Further research is recommended to fill the knowledge gap regarding the cardiac anatomy features for cardiovascular risk assessment.

Introduction: Acute Pulmonary thromboembolism (PTE) is an imperative medical condition with a considerable global impact. Inflammation is deemed to take a notable part in the pathophysiology of this potentially fatal disorder. The aim of the current study was to predict acute PTE severity in helical pulmonary CT-angiography using easily accessible hematological complete blood count (CBC) indices.Methods: After exclusion of inflammatory conditions that may affect CBC parameters, a total of 69 consecutive patients with definite diagnosis of acute PTE according to pulmonary helical CT –angiography were recruited. Laboratory tests, including CBC parameters were performed on admission in the emergency unit, before initiation of any therapy. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and RDW to platelet ratio (RPR) were calculated in each case of acute PTE. Ultimately, CT pulmonary arterial obstruction index (PAOI) was assessed subsequent to pulmonary helical CT-angiography for each patient.Results: We found that NLR is positively correlated with acute PTE severity according to CT pulmonary arterial obstruction index (PAOI) (P 0.05).Conclusions: NLR could be an easily calculated and capable index to predict severity of acute PTE in pulmonary CT-angiography. Consequently, NLR might be used in precise risk stratification when suspicious for acute PTE and in accurately triage of patients who would benefit greatly from urgent diagnostic and therapeutic interventions.

Purpose: Pulmonary embolism (PE) is a potentially fatal cardiopulmonary disease; therefore, rapid risk stratification is necessary to make decisions of appropriate management strategies. The aim of this study was to assess various computed tomography (CT) findings in order to find new prognostic factors of adverse outcome and mortality. Material and methods: The study enrolled 104 patients with acute PE. Based on their outcome, patients were categorised into four groups. Comorbidities such as ischaemic heart disease were obtained from their medical records. Patients CT angiography were reviewed for recording variables such as main pulmonary artery diameter and right ventricle (RV)/left ventricle (LV) ratio. Patient deaths up to three months since diagnosis of PE had been registered. Logistic regression analysis was performed to find predictors. Results: Based on multiple logistic regression, RV/LV ratio, LV diameter, and right-sided pulmonary infarction are predictors of mortality in 30 days. An RV/LV ratio of 1.19 could successfully discriminate patients who died within 30 days and those who did not. Conclusions: RV/LV ratio, LV diameter, right-sided pulmonary infarction, assessed with helical CT, can help predict 30-day mortality.

Background. Coronary artery disease (CAD) is the foremost cause of death in the most developed societies. Plaque formation in epicardial coronary arteries and ensuing inflammation are a known pathophysiologic factor of CAD. Objectives. We aimed to separately and simultaneously evaluate the correlation between pericardial fat pad volume and overall peri-coronary epicardial adipose tissue (EAT) thickness with coronary calcium score (CCS) to improve risk stratification of CAD. Methods. We retrospectively reviewed patients who underwent a non-invasive contrast-enhanced coronary multidetector CT (MDCT) angiography. Peri-coronary EAT thickness, pericardial fat pad volume and CCS were obtained by an expert radiologist from the patients coronary multidetector CT (MDCT) angiography. Results. We included 141 symptomatic patients (86 men, 55 women) with an average age of 53.53 ± 12.92. An increment of overall peri-coronary EAT thickness (1/3 × (left anterior descending artery (LAD) + left circumflex artery (LCx) + right coronary artery (RCA)) was associated with a 49% increase in the odds for the presence of coronary artery calcification (CAC) (P = 0.004). Significant predictability of peri-coronary EAT-average was seen in diagnosing calcified plaque. Pericardial fat pad volume was positively correlated with overall peri-coronary EAT thickness in age and body mass index (BMI)-adjusted linear regression models, (P < 0.001). Conclusion. Our results amplify previous idea that peri-coronary EAT and pericardial fat pad volume might act as useful markers and better indicators of CCS based on Agatston score in comparison with BMI or body weight in order to reveal subsequent CADs.

Purpose. Pulmonary embolism (PE) is a common and potentially fatal form of venous thromboembolism. The aim of this study is to investigate the association between the pulmonary arterial obstruction index and atrial size in patients with acute pulmonary embolism. Basic Procedure. The study consisted of 86 patients with clinical symptoms of PE. Out of 86 individuals, 50 patients were diagnosed with PE and considered as the patient group. The others were considered as the control group. All patients were scanned by a multidetector CT scanner. Using the radiology workstation, an expert radiologist calculated the left atrium (LA) and right atrium (RA) areas from planimetric measurements obtained from free-hand delineation of the atrial boarders using an electronic pen. Quantitative volumetric measurements of LA and RA were obtained from original axial images. Main Findings. There were 25 males and 25 females with PE, who had a mean age of 58 years. There was not a significant difference in the positive history of diabetes mellitus, hypertension, asthma, chronic obstructive pulmonary diseases, ischemic heart disease, and smoking between patients and control group. There was a significant negative correlation between almost all LA measurements and the PAOI. RA area and volume had the highest area under the curves for recognizing larger clot burden. Principal Conclusions. A higher clot load is associated with a smaller LA size and increased RA/LA ratios, measured with CTPA. Atrial measurements are correlated with POAI, and they could be used as sensitive parameters in predicting heart failure in patients with PE.

Background: Adjuvant radiation therapy (RT) improves the prognosis of breast cancer (BC); nevertheless, causes post-RT complications. One of the most life-threatening complications of RT in BC patients is atherosclerotic coronary artery disease (CAD). Compared with old two-dimensional RT (2D-RT), newer three-dimensional conformal radiotherapy (3D-CRT) protects normal tissues including the heart from irradiation. Early detection of plaques using coronary artery calcium score (CACS) could improve the post-RT BC survivors’ outcomes. Objectives: This study assessed CACS in BC patients who underwent 3D-CRT to find whether there is any significant difference between their CACS and those of non-BC patients. Patients and Methods: CACS of fifty BC patients with different intervals from RT - case - and fifty women with no history of BC or RT - control - using 64-slice ECG-gated CT scan were assessed as Agatston score (AS). The risk factors of CAD, the Framingham’s 10-year risk score, and the age-matched CACS percentiles were evaluated. Results: No AS difference between the case and control was found. No correlation between AS and RT-to-follow-up time interval, laterality of BC, Framingham’s 10-year risk score or traditional CAD risk factors were detected. Increase in CACS related to the senile atherosclerotic process was shown (P < 0.001). Conclusion: No significant difference in CACS was found in BC patients treated by 3D-CRT in comparison with those of non-BC individuals or BC patients who treated by 2D-RT. This finding may be the result of either the non-calcified nature of radiation-induced CAD plaques or reduced cardiac radiation in 3D-CRT, leading to myocardial microvascular disease rather than senile calcified atherosclerotic plaques. CACS may not be an appropriate screening test to detect early CAD in these patients.

Background. It is now suggested an association between non-alcoholic fatty liver disease (NAFLD) and the occurrence of coronary artery disease even in non-diabetic patients. We will determine the rate of NAFLD and its main determinants in non-diabetic patients undergoing coronary angiography. Methods. This cross-sectional study was accomplished on 264 patients who were candidates for coronary angiography during the year 2016. Coronary angiography has been done to depict the presence or absence of coronary involvement, and the severity of coronary artery disease by determining the number of vessels involved and also the SYNTAX score. During 48 hours after coronary angiography, the patients underwent abdominal ultrasonography for detection of NAFLD. Results. The overall prevalence of NAFLD in the patients was 72.3%. The prevalence of NAFLD in those with and without coronary involvement was 71.9% and 73.1% respectively, with no notable difference (p = 0.837). The mean SYNTAX score in the patients with and without NAFLD was 22.32 ± 11.10 and 21.75 ± 10.71 respectively with no difference (p = 0.702). According to the multivariable regression models, the presence of NAFLD could not predict the likelihood of coronary artery disease (OR = 0.879, p = 0.669) or its severity assessed by the SYNTAX score (beta = 0.046, p = 0.456). NAFLD grade was also not a determinant for coronary artery disease (OR = 1.139, p = 0.178) or its severity (beta = 0.058, p = 0.165). Conclusion. It seems that the presence and grade of NAFLD may not be correlated with atherosclerotic involvement of coronary arteries and its severity in non-diabetic patients. Future large studies and trials could elucidate the independent role of fatty liver in nondiabetic non-alcoholic patients.

There is evidence of association between aging and increase in the normal upper limit of the common bile duct (CBD) diameter. As aging is a documented risk factor for atherosclerosis, and the possible effect that atherosclerosis can have on the CBD diameter via affecting its smooth muscle contractility and blood flow, we decided to determine the association between CBD diameter and atherosclerosis in the abdominal aorta (AA). A total of 99 asymptomatic patients (53 males and 46 females; age range of 18–88 years) without history of cholecystectomy who underwent abdominal contrast-enhanced CT scan were included. The CBD diameter was measured. The atherosclerosis of AA was quantified by Agatston score. Mean (± SD) CBD diameter was 6.14 (± 1.95) mm; range = 2.4–12.7 mm. Agatston score was 0 in 59 patients. In the remaining 40 patients, median (interquartile range, IQR) Agatston score was 497.5 (2026.3). Mean (± SD) CBD diameter in patients with Agatston score > 0 was 7.39 (± 2.07) mm compared to 5.29 (± 1.32) mm in patients without calcification plaque (P

Background: Breast cancer (BC) mortality rate has significantly decreased during the past decades by introducing adjuvant chemotherapy and/or radiotherapy (RT) in addition to surgery. However, as an emerging phenomenon, the corresponding therapeutic side effects caused non-malignant morbidity and mortality. Coronary artery disease (CAD) is the leading non-malignant cause of death in BC patients. It is established that chest RT has a role in atherosclerotic plaque formation in the coronary arteries. Newer techniques of RT like three-dimensional conformal radiotherapy (3D-CRT) use technical methods in which less radiation doses are given to the non-cancerous tissues. Non-invasive technique of coronary artery calcium score (CACS) can detect atherosclerotic plaques long before the plaques become symptomatic, helping to treat them in early stages, so improve BC patients’ outcome. The aim of this study is to assess and compare CACS in BC patients with a history of 3D-RT and non-BC women in the same age range with no history of RT. Methods: CACS of fifty BC patients (age range: 34 - 70 years) with different time intervals from RT (range: 3-9 years) and CACS of fifty age-matched control group of non-BC women with no history of chest RT, using 64-slice ECG-gated CT scan were calculated and presented as the quantitative value of Agatston score (AS). The risk factors contributing to CAD (hypertension, hyperlipidemia, diabetes mellitus, smoking), and the Framingham’s 10-year risk score, as well as the age-matched CACS percentiles, were evaluated. Results: No correlation between AS and history of RT, RT-to-follow-up time interval, laterality of BC, Framingham’s 10-year risk score or traditional CAD risk factors were detected. Increase in CACS related to the senile atherosclerotic process was shown (P < 0.001). Conclusions: No difference between CACS was noted between BC patients with a history of 3D-CRT and the non-BC women without a history of RT. Although cardiac radiation dose reduction in 3D-CRT technique can justify the findings, as multiple studies have shown increase of CAD in BC patients with history of old RT techniques, but some studies show no difference in CACS between new and old RT techniques, other reason would be non-calcified atherosclerotic plaques after RT or myocardial microvascular disease due to reduced cardiac doses after 3D-CRT rather than calcified atherosclerotic plaques seen naturally by aging.

Shoulder adhesive capsulitis is a condition mainly characterized by a decreased range of motion (ROM), with a lifelong prevalence of 2–5 %. Intra-articular steroid injection is an important treatment in this disease. It has been suggested that ultrasound-guided (US-guided) intra-articular injections are more accurate and effective than blind injections. This randomized clinical trial was designed to compare efficacy and accuracy of US-guided injections versus blind injections of steroid in the glenohumeral joint. Forty-one patients diagnosed with shoulder adhesive capsulitis were included. Patients randomly underwent intra-articular injection either blind or under guidance of ultrasound by a specialist. Immediately after injection, radiograms were obtained to assess the accuracy of injection. Demographic characteristics, their functional status, the severity of pain, and the ROM were gathered and compared between the two groups. Twenty patients in the US-guided group and 21 in the blind group finished the 4-week period of the study. Improvements in pain, ROM, and functional score after 1 and 4 weeks were more prominent in the US-guided group, but the differences were not statistically significant, except for the changes in extension where the improvements were significantly higher in the US-guided group (p = 0.01). The accuracy of injections was also higher in the US-guided group (90 % vs. 76.19 %), but the differences were not found to be significant (p = 0.24). US-guided injections can be more accurate and yield better improvements in pain, ROM, and function of the patients, but they cost more and are time-consuming.

Origination of the right coronary artery (RCA) from the left anterior descending (LAD) artery is a case of single coronary artery. It is an extremely rare coronary artery abnormality and usually an incidental finding during coronary angiography. A 73-year-old man with a medical history of hypertension arrived with chest pain. Medical therapy started for ST elevated myocardial ischemia. During his diagnostic coronary angiogram, RCA was visualized as abnormally orientating from the mid-portion of LAD. A significant lesion in the proximal part of LAD, significant long lesion in the diagonal artery, and several stenoses in the obtuse marginal artery (OMA) were observed. To evaluate the course of RCA, coronary computed tomography angiography (coronary CTA) scan was performed. The patient underwent coronary artery bypass graft (CABG) for three vessels. He was discharged without any complication and no problems were detected in follow-up. In conclusion, if during classic angiography, RCA is not seen, the physician should keep in mind that RCA may originate from LAD. Current classification cannot exactly determine this anomaly and needs revision. When there is suspicion for coronary anomaly, performing coronary CTA can be helpful for better management and planning of therapy.

Recently, attempts have been made to quantify the clot burden on the basis of CT angiographic findings. The development of clot burden index [pulmonary arterial obstruction index (PAOI)] may have important prognostic and therapeutic implications and may provide a reproducible standard for measuring response to thrombolytic therapy. The presence of right ventricular dysfunction (RVD) is a marker for adverse clinical outcome in patients with acute pulmonary embolism (PE). The ratio of the right ventricle to left ventricle short axis diameters (RV/LV) has been proposed as an accurate sign for the presence of RVD. Other studies suggested that the quantification of a clot at pulmonary computed tomography (CT) angiography is an important predictor of right heart failure and patients' outcome in the setting of PE. In this study, we assess the measurement of PAOI and RV/LV ratio in pulmonary CT angiography and discuss the significant correlations between them. Patients and Methods: The study population comprised 42 patients (19 women, 23 men; mean age, 52 + 18 years) with the definite diagnosis of PE based on their pulmonary CT angiography. The CT angiographies of patients were reviewed, and PAOI and RV/LV ratio were measured. PAOI was calculated from the size of embolus and the location of thrombus on CT images in accordance with another study by Qanadli et al. The index was defined as the product of N x D, where N was the value of the proximal clot site, equal to the number of segmental bronchial branches, and D was the degree of obstruction, defined as 1 for partial obstruction and 2 for total obstruction. Furthermore, the scans were evaluated by measuring the minor axes of the right and left ventricles of the heart in the transverse plane at their widest points between the inner surface of the free wall and interventricular septum. By using logistic regression, PAOIs were compared with RV/LV ratio. Correlation between PAOI and RV/LV ratio was evaluated by Spearman correlation test, and receiver operating characteristic (ROC) curve was used to determine an optimal cut-off value for PAOI. : Results: In our study group, mean PAOI was 24.3 + 19.2%. Nine cases (21.4%) had a PAOI of more than 40%. The mean RV/LV ratio was 1.03 + 0.25; eighteen patients (43%) had an RV/LV ratio of more than 1; twenty-four patients (57%) had an RV/LV ratio of less than 1. There was a statistically significant correlation between PAOI and RV/LV ratio (P = 0.007; r = 0.4). The mean PAOI of patients with RV/LV ratio of >1 was significantly higher than that of patients with RV/LV ratio of ? 1 (32.6% vs. 18.1%; P = 0.02). However, based on ROC analysis, an ideal cut-off value for PAOI could not be defined. Also, there was no significant difference in PAOIs between different age (P > 0.05) and sex (P > 0.05) groups. Conclusion: Our findings were in agreement with those of Wu et al. and suggested that the quantification of a clot at CT pulmonary angiography is an important predictor of right heart failure and determines patients' outcome in the setting of PE. There was a significant correlation between PAOI and RV/LV ratio in PE. However, there was no ideal PAOI cut-off value for the diagnosis of right ventricular dysfunction (RV/LV ratio > 1). Further studies with a larger study population may be necessary to generalize our findings and to suggest a sensitive and specific cut-off point for ventricular dysfunction in patients with PE. The prognostic role of RV/LV ratio and obstruction index on spiral CT may also warrant further investigation in patients with PE.

With advent of transcatheter aortic valve implantation, using multislice computed tomography (MSCT) to provide detailed data about aortic root has become more crucial. We compared aortic dimension changes during cardiac cycle in patients with and without aortic valve calcification and evaluated its correlation with aortic valve calcium score in former group. Fifty-two patients with and 52 subjects without aortic valve calcification underwent coronary MSCT using two 64-slice and a dual-source 256-slice CT scanners. Aortic root dimensions were measured in both systolic and diastolic phases. Changes in annular maximum diameter (D(max)), minimum diameter (D(min)), cross sectional area and perimeter, three diameters of sinuses of Valsalva (V(a), V(b) and V(c)), sinotubular junction maximum (STJ(max)) and minimum (STJ(min)) diameters between systolic and diastolic phases (systole minus diastole) were -0.59 mm, -0.05 mm, -2.53 mm(2), -1.48 mm, +0.91 mm, +1.08 mm, +0.42 mm, +0.63 mm, +0.40 mm and in those without aortic calcification -0.33 mm, 0.00 mm, -6.92 mm(2), -0.41 mm, +0.30 mm, +0.38 mm, +0.61 mm, +0.33 mm, +0.20 mm in patients with aortic calcification, respectively. Apart from two diameters in sinuses of Valsalva (V(a) and V(b)), changes in all other diameters of aortic root during cardiac cycle were not significantly different between the two groups. Furthermore, in patients with aortic calcification, no significant correlation was detected between changes in nearly all aortic root dimensions during cardiac cycle and aortic valve calcium score or location of calcification (annular, commissural or both).