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  • 1
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    Online Resource
    Does mitral regurgitation reduce the risks of thrombosis in atrial fibrillation and flutter?
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of Cardiovascular Medicine Vol. 20, No. 10 ( 2019-10), p. 660-666
    Details
    In: Journal of Cardiovascular Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 20, No. 10 ( 2019-10), p. 660-666
    Abstract: Blood stasis is the main cause of left atrial thrombosis (LAT) in atrial tachyarrhythmias. The high-velocity flow inside the left atrium, due to mitral valve regurgitation, may prevent clot formation but the topic has never been investigated in large-scale studies. The aim of our study was to evaluate whether the presence and degree of mitral regurgitation have a protective role against LAT risk. Methods A total of 1302 consecutive adult patients with paroxysmal or persistent atrial fibrillation or flutter undergoing cardioversion, submitted to transesophageal echocardiography, were retrospectively enrolled in the study. The study population was divided into three groups according to the mitral regurgitation degree: absent, mild-to-moderate and severe. Results Among 1302 patients enrolled in the study, patients without mitral regurgitation were 248 (19%), those with mild-to-moderate 970 (75%), whereas 84 had severe mitral regurgitation (6%). LAT incidence was significantly lower in patients with severe mitral regurgitation compared with those with mild-to-moderate (mitral regurgitation) (2.4 vs. 8.9%, P   〈  0.05), and similar to subjects without mitral regurgitation (2.4%). Conclusion Despite patients with severe regurgitation having clinical and echo characteristics predisposing to LAT (higher age, heart failure, higher atrial size, lower ventricular function) thrombosis prevalence was significantly lower than for those with mild-to-moderate mitral regurgitation. The percentage of LAT in severe mitral regurgitation cases was very low and similar to that of cases without regurgitation which were characterized by lower age, normal left ventricular function or other risk factors, reinforcing the hypothesis of a protecting role against atrial thrombosis of mitral regurgitation.
    Type of Medium: Online Resource
    ISSN: 1558-2027 , 1558-2035
    URL: Article
    DOI: 10.2459/JCM.0000000000000838
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 2
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    The STRATEGY Study (Stress Cardiac Magnetic Resonance Versus Computed Tomography Coronary Angiography for the Management of Symptomatic Revascularized Patients) : Resources and Outcomes Impact
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation: Cardiovascular Imaging Vol. 9, No. 10 ( 2016-10)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 10 ( 2016-10)
    Abstract: Computed tomography coronary angiography (cTCA) and stress cardiac magnetic resonance (stress-CMR) are suitable tools for diagnosing obstructive coronary artery disease in symptomatic patients with previous history of revascularization. However, performance appraisal of noninvasive tests must take in account the consequent diagnostic testing, invasive procedures, clinical outcomes, radiation exposure, and cumulative costs rather than their diagnostic accuracy only. We aimed to compare an anatomic (cTCA) versus a functional (stress-CMR) strategy in symptomatic patients with previous myocardial revascularization procedures. Methods and Results— Six hundred patients with chest pain and previous revascularization included in a prospective observational registry and evaluated by clinically indicated cTCA (n=300, mean age 68.2±9.7 years, male 255) or stress-CMR (n=300, mean age 67.6±9.7 years, male 263) were enrolled and followed-up in terms of subsequent noninvasive tests, invasive coronary angiography, revascularization procedures, cumulative effective radiation dose, major adverse cardiac events, defined as a composite end point of nonfatal myocardial infarction and cardiac death, and medical costs. The mean follow-up for cTCA and stress-CMR groups was similar (773.6±345 versus 752.8±291 days; P =0.21). Compared with stress-CMR, cTCA was associated with a higher rate of subsequent noninvasive tests (28% versus 17%; P =0.0009), invasive coronary angiography (31% versus 20%; P =0.0009), and revascularization procedures (24% versus 16%; P =0.007). Stress-CMR strategy was associated with a significant reduction of radiation exposure and cumulative costs (59% and 24%, respectively; P 〈 0.001). Finally, patients undergoing stress-CMR showed a lower rate of major adverse cardiac events (5% versus 10%; P 〈 0.010) and cost-effectiveness ratio (119.98±250.92 versus 218.12±298.45 Euro/y; P 〈 0.001). Conclusions— Compared with cTCA, stress-CMR is more cost-effective in symptomatic revascularized patients.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.116.005171
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 3
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    Abstract 10990: The Prognostic Significance of Right Ventricular Dilation Assessed by Cardiac Magnetic Resonance Imaging in Heart Failure With Reduced Ejection Fraction
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Background: Quantitative volumetric assessment of the right ventricle (RV) can significantly enhance risk stratification in heart failure (HF), especially with the increasing availability of cardiac MRI (CMR). The prognostic value of RV dilation measured by RV end diastolic volume indexed to body surface area (RVEDVi) is not yet well established. In this analysis, we investigate the prognostic significance of RVEDVi measured by CMR in a stable HF cohort. Methods: We conducted a retrospective analysis on the DERIVATE registry, a large cohort of stable HF patients who underwent baseline CMR and echocardiography assessment. We used the cut-off value 90ml/m 2 as the upper limit of normal for CMR-derived RVEDVi. The primary outcome was all-cause mortality (ACM), while the secondary outcome was a composite of ACM and/or heart failure hospitalization (HFH). A Cox proportional hazard model was used to evaluate the association with outcomes. Results: 2,447 patients with HF and reduced ejection fraction (HFrEF) were included, with a median follow-up time of 959 days (IQR: 560-1590). Mean LVEF was 34.0 ± 10.8, mean age was 59.8 ± 14.0 years and 42% were females. Mean RVEDVi was 75.0 ± 29.4 ml/m 2 and 23.2% had an RVEDVi 〉 90 ml/m 2 . Elevated RVEDVi ( 〉 90 ml/m 2 ) was significantly associated with an increased risk for ACM (aHR= 1.40, 95% CI [1.17-1.67] p =0.01) and the composite of ACM/HFH (aHR= 1.40, 95% CI [1.03-1.90] p = 0.03). Conclusion: In a large cohort of HFrEF undergoing baseline CMR, elevated RVEDVi was associated with an increased risk of ACM and ACM and/or HFH, independent of LV systolic function.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.10990
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 4
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    Prognostic Benefit of Cardiac Magnetic Resonance Over Transthoracic Echocardiography for the Assessment of Ischemic and Nonischemic Dilated Cardiomyopathy Patients Referred for the Evaluation of Primary Prevention Implantable Cardioverter–Defibrillator Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation: Cardiovascular Imaging Vol. 9, No. 10 ( 2016-10)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 10 ( 2016-10)
    Abstract: The aim of this study was to determine the prognostic benefit of cardiac magnetic resonance (CMR) over transthoracic echocardiography (TTE) in ischemic cardiomyopathy and nonischemic dilated cardiomyopathy patients evaluated for primary prevention implantable cardioverter–defibrillator therapy. Methods and Results— We enrolled 409 consecutive ischemic and dilated cardiomyopathy patients (mean age: 64±12 years; 331 men). All patients underwent TTE and CMR, and left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricle ejection fraction (LVEF) were evaluated. In addition, late gadolinium enhancement was also assessed. All patients were followed up for major adverse cardiac events (MACE) defined as a composite end point of long runs of nonsustained ventricular tachycardia, sustained ventricular tachycardia, aborted sudden cardiac death, or sudden cardiac death. The median follow-up was 545 days. CMR showed higher left ventricle end-diastolic volume (mean difference: 43±22.5 mL), higher left ventricle end-systolic volume (mean difference: 34±20.5 mL), and lower LVEF (mean difference: −4.9±10%) as compared to TTE ( P 〈 0.01). MACE occurred in 103 (25%) patients. Patients experiencing MACE showed higher left ventricle end-diastolic volume, higher left ventricle end-systolic volume, and lower LVEF with both imaging modalities and higher late gadolinium enhancement per-patient prevalence as compared to patients without MACE. At multivariable analysis, CMR-LVEF ≤35% (hazard ratio=2.18 [1.3–3.8]) and the presence of late gadolinium enhancement (hazard ratio=2.2 [1.4–3.6] ) were independently associated with MACE ( P 〈 0.01). A model based on CMR-LVEF ≤35% or CMR-LVEF ≤35% plus late gadolinium enhancement detection showed a higher performance in the prediction of MACE as compared to TTE-LVEF resulting in net reclassification improvement of 0.468 (95% confidence interval, 0.283–0.654; P 〈 0.001) and 0.413 (95% confidence interval, 0.23–0.63; P 〈 0.001), respectively. Conclusions— CMR provides additional prognostic stratification as compared to TTE, which may have direct impact on the indication of implantable cardioverter–defibrillator implantation.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.115.004956
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 5
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    Image Quality, Overall Evaluability, and Effective Radiation Dose of Coronary Computed Tomography Angiography With Prospective Electrocardiographic Triggering Plus Intracycle Motion Correction Algorithm in Patients With a Heart Rate Over 65 Beats Per Minute
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Thoracic Imaging Vol. 33, No. 4 ( 2018-07), p. 225-231
    Details
    In: Journal of Thoracic Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 4 ( 2018-07), p. 225-231
    Abstract: Recently, a new intracycle motion correction algorithm (MCA) was introduced to reduce motion artifacts from heart rate (HR) in coronary computed tomography angiography (cCTA). The aim of the study was to evaluate the image quality, overall evaluability, and effective radiation dose (ED) of cCTA with prospective electrocardiographic (ECG) triggering plus MCA as compared with standard protocol with retrospective ECG triggering in patients with HR≥65 bpm. Materials and Methods: One hundred consecutive patients (67±10 y) scheduled for cCTA with 65 〈 HR 〈 80 bpm were retrospectively analyzed. The patients were assigned to 2 groups undergoing prospective (group 1) or retrospective (group 2) triggered cCTA. The study protocol was approved by the Institutional Ethics Committee and a written informed consent was obtained from all patients. Image noise, signal to noise ratio, contrast to noise ratio, Likert image quality score (score 1, nondiagnostic; score 2, adequate; score 3, good; score 4, excellent), overall image evaluability, and ED were measured and compared between the 2 groups. Both vessel-based and patient-based analyses were evaluated. Student test or Wilcoxon test were used to evaluate differences of continuous variables, whereas the χ 2 test was used to study differences with regard to categorical data. A P -value 〈 0.05 was considered statistically significant. Results: cCTA was successfully performed in all patients. In a segment-based model, group 1 compared with group 2 showed a lower rate of overall artifacts (67% vs. 83%; P 〈 0.001) and motion artifacts (49% vs. 66%; P 〈 0.001), resulting in a better Likert image quality score (2.83±1.03 vs. 2.37±1.02; P 〈 0.01) and overall evaluability (85% vs. 75%; P 〈 0.01). Group 1 showed a lower ED as compared with group 2 (3.1±1.9 vs. 11.9±3.3 mSv; P 〈 0.01). Conclusion: MCA and cCTA with prospective ECG-triggering acquisition in patients with high HR improves image quality and overall evaluability compared with cCTA with standard retrospective ECG triggering.
    Type of Medium: Online Resource
    ISSN: 0883-5993
    URL: Article
    DOI: 10.1097/RTI.0000000000000320
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 6
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    Prognostic Stratification of Patients With ST-Segment–Elevation Myocardial Infarction (PROSPECT) : A Cardiac Magnetic Resonance Study
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Circulation: Cardiovascular Imaging Vol. 10, No. 11 ( 2017-11)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 11 ( 2017-11)
    Abstract: Cardiac magnetic resonance (CMR) is a robust tool to evaluate left ventricular ejection fraction (LVEF), myocardial salvage index, microvascular obstruction, and myocardial hemorrhage in patients with ST-segment–elevation myocardial infarction. We evaluated the additional prognostic benefit of a CMR score over standard prognostic stratification with global registry of acute coronary events (GRACE) score and transthoracic echocardiography LVEF measurement. Methods and Results— Two hundred nine consecutive patients with ST-segment–elevation myocardial infarction (age, 61.4±11.4 years; 162 men) underwent transthoracic echocardiography and CMR after succesful primary percutaneous coronary intervention. Major adverse cardiac events (MACE) were assessed at a mean follow-up of 2.5±1.2 years. MACE occurred in 24 (12%) patients who at baseline showed higher GRACE risk score ( P 〈 0.01), lower LVEF with both transthoracic echocardiography and CMR, lower myocardial salvage index, and higher per-patient myocardial hemorrhage and microvascular obstruction prevalence and amount as compared with patients without MACE ( P 〈 0.01). The best cut-off values of transthoracic echocardiography-LVEF, CMR-LVEF, myocardial salvage index, and microvascular obstruction to predict MACE were 46.7%, 37.5%, 0.4, and 2.6% of left ventricular mass, respectively. Accordingly, a weighted CMR score, including the following 4 variables (CMR-LVEF, myocardial salvage index, microvascular obstruction, and myocardial hemorrhage), with a maximum of 17 points was calculated and included in the multivariable analysis showing that only CMR score (hazard ratio, 1.867 per SD increase [1.311–2.658] ; P 〈 0.001) was independently associated with MACE with the highest net reclassification improvement as compared to GRACE score and transthoracic echocardiography-LVEF measurement. Conclusions— CMR score provides incremental prognostic stratification as compared with GRACE score and transthoracic echocardiography-LVEF and may impact the management of patients with ST-segment–elevation myocardial infarction.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.117.006428
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 7
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    Comparison of Image Processing Techniques for Nonviable Tissue Quantification in Late Gadolinium Enhancement Cardiac Magnetic Resonance Images
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Journal of Thoracic Imaging Vol. 31, No. 3 ( 2016-05), p. 168-176
    Details
    In: Journal of Thoracic Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 3 ( 2016-05), p. 168-176
    Abstract: The aim of this study was to compare the performance of quantitative methods, either semiautomated or automated, for left ventricular (LV) nonviable tissue analysis from cardiac magnetic resonance late gadolinium enhancement (CMR-LGE) images. Materials and Methods: The investigated segmentation techniques were: (i) n-standard deviations thresholding; (ii) full width at half maximum thresholding; (iii) Gaussian mixture model classification; and (iv) fuzzy c-means clustering. These algorithms were applied either in each short axis slice (single-slice approach) or globally considering the entire short-axis stack covering the LV (global approach). CMR-LGE images from 20 patients with ischemic cardiomyopathy were retrospectively selected, and results from each technique were assessed against manual tracing. Results: All methods provided comparable performance in terms of accuracy in scar detection, computation of local transmurality, and high correlation in scar mass compared with the manual technique. In general, no significant difference between single-slice and global approach was noted. The reproducibility of manual and investigated techniques was confirmed in all cases with slightly lower results for the nSD approach. Conclusions: Automated techniques resulted in accurate and reproducible evaluation of LV scars from CMR-LGE in ischemic patients with performance similar to the manual technique. Their application could minimize user interaction and computational time, even when compared with semiautomated approaches.
    Type of Medium: Online Resource
    ISSN: 0883-5993
    URL: Article
    DOI: 10.1097/RTI.0000000000000206
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 8
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    Technological Advancements in Echocardiographic Assessment of Thoracic Aortic Dilatation : Head to Head Comparison Among Multidetector Computed Tomography, 2-Dimensional, and 3-Dimensional Echocardiography Measurements
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Thoracic Imaging Vol. 33, No. 4 ( 2018-07), p. 232-239
    Details
    In: Journal of Thoracic Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 4 ( 2018-07), p. 232-239
    Abstract: The aim of this study was to evaluate the feasibility and accuracy of 2-dimensional (2D) and 3-dimensional (3D) transthoracic echocardiography (2DTTE, 3DTTE) versus multidetector computed tomography (MDCT) in patients with ascending aortic (AA) dilation. Materials and Methods: Fifty consecutive patients with AA dilation were evaluated by 2DTTE, X-plane (XP) 3DTTE, and MDCT. Aorta diameters were measured at aortic annulus, aortic root (SIN), sinotubular junction, AA, aortic arch before the prebrachiocephalic artery (PRE), and before left subclavian artery (INTRA). Leading edge-to-leading edge (L-L) and inner-to-inner (I-I) measurements were compared with MDCT data. Results: Feasibility, quality of imaging, and accuracy was high with all echocardiographic methods. Specifically for MDCT maximum SIN diameter, the best correlation and agreement was obtained using XP maximum diameter at 3DTTE (MDCT: 44.8±7.4 mm vs. XP: 44.4±7.4 mm; r =0.975; bias=−0.4 mm). The same was true for AA maximum diameter at MDCT (MDCT: 46.6±8.1 mm vs. XP: 47.5±8.1 mm; r =0.991; bias=0.1 mm). For aortic arch the best correlation and agreement with MDCT were as follows: 2DTTE L-L diameter for arch PRE (MDCT: 37.9±5.3 mm vs. TTE: 36.6±4.5 mm; r =0.927; bias=−0.9 mm) and MDCT minimum diameter with XP minimum diameter for arch INTRA (MDCT: 28.2±5.0 mm vs. TTE 28.8±4.7 mm; r =0.939; bias=−0.3 mm). Conclusion: In patients with aortic dilatation or aneurysm, new techniques (mainly 2D-3D probes allowing XP views) facilitate accuracy of aortic measurements at different sites of the vessel and allow standardization of analysis to better compare with MDCT.
    Type of Medium: Online Resource
    ISSN: 0883-5993
    URL: Article
    DOI: 10.1097/RTI.0000000000000330
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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