The International Journal of Cardiovascular Imaging

Purvis, J.; Roberts, M.; Harbinson, M.

doi: 10.1007/s10554-009-9512-8pmid: 19774484

Chronic constrictive pericarditis (CCP) is a clinical syndrome caused by compression of the heart due to a thickened or rigid pericardium. In the affluent West, the majority of cases of CCP are neither tuberculous nor calcific. In an American cohort undergoing pericardectomy for the condition, only 27% had calcification and under 10% had TB [1]. As a result, pericardial calcification (PC) as a marker of CCP has become neglected. We present a 48-year-old male admitted with atrial flutter, acute chest infection and signs of right heart congestion. PC was documented one year previously on a non-contrast CT chest. On this occasion, cardiac catheterisation confirmed hemodynamically significant CCP and cardiac magnetic resonance (cMR) study showed contiguous mass lesions in the pericardium, compression of the right ventricle, enlargement of the right atrium, hepatic enlargement and a pneumonic process in the left lung. He was commenced on antibiotics and anti-tuberculous therapy with a diagnosis of bacterial super-infection of tuberculous CCP. This was confirmed at pericardectomy along with an infected fistula into the left lung. Any finding of PC should be followed up with a thorough haemodynamic and anatomical assessment using any of a wide range of non-invasive imaging modalities.

Tu, Shengxian; Koning, Gerhard; Jukema, Wouter; Reiber, Johan

doi: 10.1007/s10554-009-9509-3pmid: 19763876

Three-dimensional quantitative coronary angiography (3D QCA) has been encouraged by the increasing need to better assess vessel dimensions and geometry for interventional purposes. A novel 3D QCA system based on biplane X-ray angiograms is presented in this paper. By correcting for the isocenter offset and by improving the epipolar constraint for corresponding two angiographic projections, accurate and robust reconstruction of the vessel centerline is achieved and the reproducibility of its applications, e.g., the assessments of obstruction length and optimal viewing angle, is guaranteed. The accuracy and variability in assessing the obstruction length and optimal bifurcation viewing angle were investigated by using phantom experiments. The segment length assessed by 3D QCA correlated well with the true wire segment length (r 2 = 0.999) and the accuracy and precision were 0.04 ± 0.25 mm (P < 0.01). 3D QCA slightly underestimated the rotation angle (difference: −1.5° ± 3.6°, P < 0.01), while no significant difference was observed for the angulation angle (difference: −0.2° ± 2.4°, P = 0.54). In conclusion, the new 3D QCA approach allows highly accurate and precise assessments of obstruction length and optimal viewing angle from X-ray angiography.

Tongeren, Robert; Hamming, Jaap; Cessie, Saskia; Erkel, Arian; Bockel, J.

doi: 10.1007/s10554-009-9507-5pmid: 19757148

Cell-based therapy has been proposed as a novel strategy for patients with severe peripheral arterial disease by stimulating vascular growth. In clinical studies of this therapy, the emphasis has been on demonstrating recovery of clinical parameters, rather than on evaluation of blood flow recovery. Angiography is still the gold standard for the assessment of lower leg arteries. Therefore, we studied the usefulness of angiography in the evaluation of cell-based therapy. Sixteen patients with critical leg ischemia (ischemic rest pain or ulcers), or persistent (>12 months) profound disabling claudication were unilaterally treated with autologous bone marrow-derived mononuclear cells. Pre- and 6 months post-treatment digital subtraction angiographies (DSA) were assessed and compared in a blinded fashion twice by a panel of seven vascular surgeons and interventional radiologists. Inter- and intraobserver variability on qualitative (poor/moderate/rich) and semi-quantitative (increase/no difference/decrease) assessment of collateral circulation were evaluated. Agreement was expressed inter- and intraclass correlation coefficients (CC). Inter- and intraobserver agreement was moderate for the qualitative grading of collateral extent (CC = 0.46 and 0.60, respectively). Agreement was moderate (inter-CC = 0.60) to good (intra-CC = 0.73) for comparing pre- and post-treatment DSA. Clinical response was based on limb salvage, pain-free walking distance, ankle-brachial pressure index and pain scores. No difference was observed in the extent of collateral circulation between pre- and post treatement DSA after separate analysis of clinical responding and non-responding patients (P = 0.92). DSA is not a suited modality for the evaluation of therapeutic angiogenesis.

Santiago, F.; Nakamura, R.; Kaplan, D.; Faria, E.

doi: 10.1007/s10554-009-9498-2pmid: 19876761

To determine whether hyperalphalipoproteinemia modifies carotid intima-media thickness (cIMT) and/or influences the relationship of clinical and biochemical parameters with cIMT. This study was conducted on 169 asymptomatic individuals, classified as hyperalphalipoproteinemic (Hyper-A) (Hyper-A, n = 71, HDL-C ≥68 mg/dL) and controls (CTL) (CTL, n = 98, HDL-C >32 and <68 mg/dL). Enzymatic, nephelometric and ultracentrifugation methods were used for biochemical determinations. Hepatic lipase (HL), lipoprotein lipase (LPL), cholesteryl ester transfer protein (CETP) and phospholipids transfer protein (PLTP) activities were measured by radiometric exogenous methods. The prevalence of dyslipidemia, hypertension, smoking, sedentariness, postmenopausal women, coronary artery disease (CAD) and familial history of CAD were determined. High resolution β-mode carotid ultrassonography was performed. The Hyper-A group was older and had higher frequencies of hypercholesterolemia (40%), hypertension (31%), sedentariness (37%) and postmenopausal women (1%). In Hyper-A individuals, the mean cIMT after adjustment for age and gender was similar between the groups (0.85 ± 0.24 mm Hyper-A versus 0.69 ± 0.17 mm CTL). In multivariate models, age was a significant predictor of cIMT in Hyper-A (R 2 = 0.04, p ≤ 0.001), independently of other clinical or biochemical factors. In contrast to CTL, where age (R 2 = 0.63 p ≤ 0.001), male sex (R 2 = 0.03, p ≤ 0.001), blood pressure (R 2 = 0.006, p ≤ 0.001) and HDL-C (R 2 = 0.02, p < 0.022) accounted for the cIMT variations. Despite an increased prevalence of cardiovascular risk factors in Hyper-A and resistance of carotid thickness to modulation by metabolic and anthropometric factors (except age), the similarity in cIMT between Hyper-A and healthy individuals emphasizes the atheroprotective effects of HDL.

Deniz, Ferhat; Ermiş, Necip; Kepez, Alper; Türk, Barış; Akkoyunlu, Murat; Kara, Batuhan; Kutlu, Mustafa

doi: 10.1007/s10554-009-9505-7pmid: 19757149

We aimed to study the vascular reactivity of young male hypogonadal hypogonadism patients without any cardiovascular risk factors and compare these findings with the ones of age-matched healthy controls. Study population consisted of 26 young male hypogonadotrophic hypogonadism patients (20.9 ± 1.3 years) and 25 age-matched healthy male controls (21.8 ± 2.9 years, P = NS). In addition to detailed hormonal analysis, each subject underwent ultrasound study of right brachial artery. Vessel diameter was measured at rest, during reactive hyperemia [endothelium-dependent flow-mediated vasodilation (FMD)] and after sublingual nitroglycerin administration (endothelium-independent vasodilation). Both flow-mediated and endothelium-independent sublingual nitroglycerin mediated dilatation values of patients were higher compared to controls (12.98 ± 10.76% vs. 7.92 ± 1.96%, P = 0.003 and 21.44 ± 10.36% vs. 14.72 ± 3.57%, P = 0.023, respectively). Linear regression analysis revealed that only serum HDL levels (relative risk 2.94, 95% CI 0.12–0.66, P = 0.006) and baseline vessel diameter (relative risk −2.77, 95% CI −17.73 to −2.70, P = 0.009) were found to be independently associated with FMD values. Endogenous male sex hormones seem to exert negative effects on vascular reactivity parameters and much of their effects are indirect that is by the way of alteration on lipid profile.

Cho, Young; Choe, Yeon; Lee, Moo-Sik

doi: 10.1007/s10554-009-9536-0pmid: 20020327

This study aimed to compare the effects of the automated and manual methods for determining the optimal phase of image reconstruction with the use of 64-slice coronary CT angiography (CCTA). In 63 patients, the optimal trigger delay was determined using an automated technique (PhaseXact) and by manual phase selection from the images reconstructed at a 10 ms and 1% increment of the R–R interval. The image quality was evaluated using four-step grading. The mean heart rate in all the patients was 70 ± 10.1 bpm (range: 52–98 bpm). The frequency of obtaining diagnostic quality images was highest with the manual absolute timing method (97.6% of 753 segments), while it was 94.7% with manual relative timing and 91.9% with an automated method. The mean image quality score (1.3 ± 0.2) based on the manual absolute timing was significantly better (P = 0.002, one-way ANOVA; P < 0.05, Scheffe’s test) than the scores determined with the use of the other two techniques (manual relative timing, 1.4 ± 0.3; automated method, 1.5 ± 0.4). The best quality coronary CT images were obtained using image reconstruction with manual absolute timing for the ECG-trigger delay, while an automated method and manual relative timing provided diagnostic quality images in most of the segments.

Davies, John; Izquierdo-Garcia, David; Rudd, James; Figg, Nichola; Richards, Hugh; Bird, Joseph; Aigbirhio, Franklin; Davenport, Anthony; Weissberg, Peter; Fryer, Tim; Warburton, Elizabeth

doi: 10.1007/s10554-009-9506-6

Beek, A.; Nijveldt, R.; Rossum, A.

doi: 10.1007/s10554-009-9499-1pmid: 19757151

Reperfusion may cause intramyocardial hemorrhage (IMH) by extravasation of erythrocytes through severely damaged endothelial walls. The purpose of the study was to evaluate the clinical significance of IMH in relation to infarct size, microvascular obstruction (MVO) and function in patients after primary percutaneous intervention. Forty-five patients underwent cardiovascular MR imaging (CMR) 1 week and 4 months after primary stenting for a first acute myocardial infarction. T2-weighted spin-echo imaging (T2W) was used to assess infarct related edema and IMH, and delayed enhancement (DE) was used to assess infarct size and MVO. Cine CMR was used to assess left ventricular volumes and function at baseline and at 4 months follow-up. In 22 (49%) patients, IMH was detected as areas of attenuated signal in the core of the high signal intensity region on T2W images. Patients with IMH had larger infarcts, higher left ventricular volumes and lower ejection fraction. Contrast-to-noise ratio (CNR) between hyperintense periphery and the hypo-intense core of the T2W ischemic area correlated to peak CKMB, total infarct size and MVO size. Using univariable analysis, CNR predicted ejection fraction at baseline (β = −0.62, P = 0.003) and follow-up (β = −0.84, P < 0.001). However, after multivariable analysis, baseline ejection fraction and presence of MVO were the only parameters that predicted functional changes at follow-up. IMH was found in the majority of patients with MVO after reperfused myocardial infarction. It was closely related to markers of infarct size, MVO and function, but did not have prognostic significance beyond MVO.

Yong, Hwan; Kim, Eung; Seo, Hong; Kang, Eun-Young; Kim, Yun; Woo, Ok; Han, Heon

doi: 10.1007/s10554-009-9542-2pmid: 19937122

Epicardial adipose tissue (EAT) may play an important role for developing an unfavorable cardiovascular risk profile. However, it has not been investigated if EAT is associated with coronary atherosclerosis in non-obese patients. We aimed to evaluate whether EAT is related to coronary atherosclerosis in non-obese patients. Among the consecutive patients who underwent coronary CT angiography (CCTA) with an intermediate pretest likelihood for having coronary artery disease, we excluded the patients whose body mass index (BMI) was over 30 kg/m2 or whose CCTA image quality was not sufficient for the detection of coronary plaque. The remaining patients were divided into the normal and abnormal groups based on the presence of atherosclerotic plaques as seen on the CCTA images. The cardiovascular risk factors were matched between the two groups. Ultimately, 100 patients were included in the normal group and 100 patients were included in the abnormal group. The pericardial fat area was measured at the subaortic level of the heart on the axial CT images. The pericardial fat area was significantly larger in the abnormal group as compared to the normal group (18.1 ± 10.2 vs. 14.6 ± 8.7 cm2, P = 0.019). Even though the overweight patients (25 ≤ BMI < 30) were excluded, the pericardial fat area was still significantly larger in the patients with coronary atherosclerotic plaque as compared to that of the patients without coronary atherosclerotic plaque (18.7 ± 11.5 vs. 13.2 ± 7.9 cm2, P = 0.006). Pericardial fat was more abundant in the non-obese patients with coronary atherosclerosis as compared to that of the patients without coronary atherosclerosis, after controlling for the other cardiovascular risk factors.

Luijnenburg, Saskia; Robbers-Visser, Daniëlle; Moelker, Adriaan; Vliegen, Hubert; Mulder, Barbara; Helbing, Willem

doi: 10.1007/s10554-009-9501-ypmid: 19757150

Cardiovascular magnetic resonance (CMR) imaging provides highly accurate measurements of biventricular volumes and mass and is frequently used in the follow-up of patients with acquired and congenital heart disease (CHD). Data on reproducibility are limited in patients with CHD, while measurements should be reproducible, since CMR imaging has a main contribution to decision making and timing of (re)interventions. The aim of this study was to assess intra-observer and interobserver variability of biventricular function, volumes and mass in a heterogeneous group of patients with CHD using CMR imaging. Thirty-five patients with CHD (7–62 years) were included in this study. A short axis set was acquired using a steady-state free precession pulse sequence. Intra-observer and interobserver variability was assessed for left ventricular (LV) and right ventricular (RV) volumes, function and mass by calculating the coefficient of variability. Intra-observer variability was between 2.9 and 6.8% and interobserver variability was between 3.9 and 10.2%. Overall, variations were smallest for biventricular end-diastolic volume and highest for biventricular end-systolic volume. Intra-observer and interobserver variability of biventricular parameters assessed by CMR imaging is good for a heterogeneous group of patients with CHD. CMR imaging is an accurate and reproducible method and should allow adequate assessment of changes in ventricular size and global ventricular function.