The International Journal of Cardiovascular Imaging

Benz, Dominik C.

doi: 10.1007/s10554-024-03321-6pmid: 39745624

Jiménez, Lina Paola Montaña; Aristizabal, Ana M.; Guzmán-Serrano, Carlos Alberto; Mejía-Quiñones, Valentina; López, Gustavo Andrés Duque; Mejia-Gonzalez, Mauricio; Mosquera-Álvarez, Walter; Gutierrez, Jaiber

doi: 10.1007/s10554-024-03265-xpmid: 39614030

Criss-Cross Heart is a congenital cardiac condition characterized by the anomalous twisting of the ventricles relative to the atria during embryonic development. The aim of this study is to assess the advantages and limitations of diagnostic imaging for the diagnosis and approach of patients with Criss-Cross Heart through a scoping review, associated to a case series. A retrospective study was conducted on four patients diagnosed with Criss-Cross Heart. Diagnostic tools including echocardiography, chest radiography, cardiac computed tomography, magnetic resonance imaging, and cardiac catheterization were evaluated. The scoping review was performed using databases such as PubMed, Lilacs, and ScienceDirect, yielding 168 articles, of which 33 were included after screening and analyzing the information within the text. Echocardiography was the most effective diagnostic modality in all the four cases, as well as according to the literature available, accurately identifying the abnormal atrioventricular connections and associated cardiac defects. Cardiac catheterization and angiography provided crucial anatomic details for surgical planning, particularly in visualizing collateral vessels and coronary artery patterns. Cardiac magnetic resonance, while underutilized in these cases, proved valuable in the literature for comprehensive structural assessment without radiation exposure. Echocardiography remains the primary diagnostic tool for Criss-Cross Heart, while cardiac catheterization, angiography, and advanced imaging like MRI offer supplementary anatomical insights critical for surgical interventions. Early and precise imaging-driven diagnosis and management significantly contribute to favorable long-term outcomes, underscoring the importance of an integrated imaging approach in managing CCH.

Sethasathien, Saviga; Leemasawat, Krit; Sittiwangkul, Rekwan; Makonkawkeyoon, Krit; Leerapun, Apinya; Kongkarnka, Sarawut; Inmutto, Nakarin; Silvilairat, Suchaya

doi: 10.1007/s10554-024-03276-8pmid: 39511127

Lee, Koeun; Han, Sangwon; Ryu, Jeongryul; Cho, Sang-Geon; Moon, Dae Hyuk

doi: 10.1007/s10554-024-03278-6pmid: 39535673

Left ventricular mechanical dyssynchrony (LVMD) is an important prognostic factor for heart failure (HF). Phase analysis of myocardial perfusion SPECT is actively being researched to evaluate LVMD. We performed a systematic review and meta-analysis on the prognostic significance of LVMD using gated SPECT in HF patient. PubMed, Embase, and the Cochrane library were searched until January 10, 2024, for studies reporting the prognostic value of LVMD in HF patients using gated SPECT for outcomes of all-cause death, cardiac death, or major adverse cardiovascular event (MACE). Hazard ratios (HRs) along with their corresponding 95% confidence intervals (CIs) were combined through meta-analysis employing a random-effects model. Funnel plots and Egger’s tests were utilized to evaluate publication bias, and trim-and-fill method were applied where bias was identified. Ten studies (2585 patients) were included; six on MACE and five on all-cause or cardiac death. Prognoses were worse in patients with LVMD assessed by SPECT than in those without LVMD, with the overall pooled HR for MACE being 2.05 (95% CI, 1.65–2.54). The pooled HR for all-cause or cardiac death was 2.08 (95% CI, 1.10–3.94); however, publication bias was present (p = 0.0024), and after adjustment, the prognostic value of LVMD was not statistically significant (HR, 1.24; 95% CI, 0.68–2.23). Assessing LVMD through myocardial perfusion SPECT proves to be a significant indicator of subsequent adverse cardiac events in HF patients. Utilizing phase analysis of SPECT could offer valuable insights for risk assessment and decision-making regarding therapy in HF patients.

Jukema, Ruurt A.; Raijmakers, Pieter G.; Hoshino, Masahiro; Driessen, Roel S.; van Diemen, Pepijn A.; Knuuti, Juhani; Maaniitty, Teemu; Twisk, Jos; Kooistra, Rolf A.; Timmer, Janny; Reiber, Johan H.C.; van der Harst, Pim; Cramer, Maarten J.; van der Hoef, Tim;

Murphy, David; Graby, John; Hudson, Benjamin; Lowe, Robert; Carson, Kevin; Kandan, Sri Raveen; McKenzie, Daniel; Khavandi, Ali; Rodrigues, Jonathan Carl Luis

doi: 10.1007/s10554-024-03281-xpmid: 39572503

Coronary Artery Disease-Reporting and Data System (CAD-RADS) standardises Computed Tomography Coronary Angiography (CTCA) reporting. Coronary calcification can overestimate stenosis. We hypothesized where CADRADS category is assigned due to predominantly calcified maximal stenosis (Ca+), the CTCA-derived Fractional Flow Reserve (FFRCT) would be lower compared to predominantly non-calcified maximal stenoses (Ca-) of the same CAD-RADS category. Consecutive patients undergoing routine clinical CTCA (September 2018 to May 2020) with ≥1 stenosis ≥25% with FFRCT correlation were included. CTCA’s were subdivided into Ca+ and Ca-. FFRCT was measured in the left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA). Potentially flow-limiting classified as FFRCT≤0.8. A subset had Invasive Coronary Angiography (ICA). 561 patients screened, 320 included (60% men, 69±10 years). Ca+ in 51%, 69% and 50% of CAD-RADS 2, 3 and 4 respectively. There was no difference in the prevalence of FFRCT≤0.8 between Ca+ and Ca- stenoses for each CAD-RADS categories. No difference was demonstrated in the median maximal stenoses FFRCT or end-vessel FFRCT within CAD-RADS 2 and 4. CAD-RADS 3 Ca+ had a lower FFRCT (maximal stenosis p= .02, end-vessel p= .005) vs Ca-. No difference in the prevalence of obstructive disease at ICA between predominantly Ca+ and Ca- for any CAD-RADS category. There was no difference in median FFRCT values or rate of obstructive disease at ICA between Ca+ and Castenosis in both CAD-RADS 2 and 4. Ca+ CAD-RADS 3 was suggestive of an underestimation based on FFRCT but not corroborated at ICA.

Cagnina, Aurelien; Salihu, Adil; Meier, David; Luangphiphat, Wongsakorn; Faltin, Benjamin; Skalidis, Ioannis; Zimmerli, Aurelia; Rotzinger, David; Dine Qanadli, Salah; Muller, Olivier; Abbe, Emmanuel; Fournier, Stephane

doi: 10.1007/s10554-024-03283-9pmid: 39514142

PurposeThis study aimed to evaluate the efficacy of the Chat Generative Pre-trained Transformer (ChatGPT) in guiding the need for invasive coronary angiography (ICA) in high-risk non-ST-elevation (NSTE) acute coronary syndrome (ACS) patients based on both standard clinical data and coronary computed tomography angiography (CCTA) findings.MethodsThis investigation is a sub-study of a larger prospective multicentric double blinded project where high-risk NSTE-ACS patients underwent CCTA prior to ICA to compare coronary lesion by both modalities. ChatGPT analyzed clinical vignettes containing patient data, electrocardiograms, troponin levels, and CCTA results to determine the necessity of ICA. The AI’s recommendations were then compared to actual ICA findings to assess its decision-making accuracy.ResultsIn total, 86 patients (age: 62 ± 13 years old, female 27%) were included. ChatGPT recommended against ICA for 19 patients, 16 of whom indeed had no significant findings. For 67 patients, ChatGPT advised proceeding with ICA, and a significant lesion was confirmed in 58 of them. Consequently, ChatGPT’s overall accuracy stood at 86%, with a sensitivity of 95% (95% confidence interval (CI) 0.76–0.92) and a specificity of 64% (95% CI 0.62–0.94). The model’s negative predictive value was 84% (95% CI 0.44–0.79), and its positive predictive value was 87% 95% CI 0.86–0.97).ConclusionPreliminary evidence suggests that ChatGPT can effectively assist in making ICA decisions for high-risk NSTE-ACS patients, potentially reducing unnecessary procedures. However, the study underscores the importance of data accuracy and calls for larger, more diverse investigations to refine artificial intelligence’s role in clinical decision-making.

El Kadi, Soufiane; Porter, Thomas R.; Hopman, Luuk H. G. A.; Verouden, Niels C.; van Rossum, Albert C.; Danad, Ibrahim; Kamp, Otto

doi: 10.1007/s10554-024-03287-5pmid: 39630353

To compare echocardiographic regional longitudinal strain with quantitative coronary angiography and assess temporal changes in regional strain in patients with STEMI and multivessel coronary artery disease. Thirty-two patients with STEMI and multivessel coronary artery disease underwent coronary angiography with 3D quantification and baseline echocardiography. Regional longitudinal strain was measured as the average strain of three adjacent myocardial segments (RLS-3S) with the most impaired strain values. Forty-one stenosed vessels were identified (9 LAD [19%], 21 LCx [50%] and 11 RCA [31%]). RLS-3S did not correlate with diameter stenosis, area stenosis or minimal luminal diameter. Receiver operating curve analysis of RLS-3S for hemodynamic significant lesions (defined as positive fractional flow reserve or composite of ≥ 70% diameter stenosis and minimal luminal diameter < 1.2 mm) demonstrated an area under the curve of 0.63 (95% CI 0.45–0.76) with an optimal cut-off value of < 9.8%. Sensitivity and specificity of RLS-3S was 86% (42–100) and 48% (31–66). RLS-3S < 9.8% at baseline in remote myocardium subtended by the stenosed coronary vessel predicted benefit from percutaneous coronary intervention in terms of regional functional recovery. RLS-3S does not correlate with individual coronary angiography measures and moderately predicts hemodynamically significant lesions. RLS-3S could be used to predict regional functional recovery after additional revascularization.Graphical abstract[graphic not available: see fulltext]

Demirci, Murat; Sayar, Nurten; Oguz, Mustafa; Kalandarov, İlkhomzhon; Ataş, Halil; Mutlu, Bülent

doi: 10.1007/s10554-024-03288-4pmid: 39576401

Pulmonary hypertension (PH) is a progressive vascular disease characterized by elevated pulmonary arterial pressure and resistance in the pulmonary vascular bed. It is associated with high morbidity and mortality. Although right heart catheterization (RHC) is the gold standard for diagnosis, noninvasive methods, such as echocardiography, are essential for early detection and management. This study aimed to elucidate the potential of right ventricular outflow tract fractional shortening (RVOT-FS) as a noninvasive diagnostic tool for PH. This single-center observational cohort study was conducted between November 2023 and May 2024. The study included 141 patients referred to the PH clinic (75 with confirmed PH and 66 controls). Echocardiographic measurements were performed using standard protocols, and RVOT-FS was calculated. Hemodynamic parameters were obtained via RHC. RVOT-FS was significantly lower in the PH group (35.71%, IQR: 27.15–43.33) than in the control group (54.50%, IQR: 45.21–69.17) (p < 0.001). RVOT-FS showed negative correlations with mean pulmonary artery pressure (mPAP) (r = − 0.664, p < 0.001), pulmonary vascular resistance (PVR) (r = − 0.526, p < 0.001), and other RHC and RV echocardiographic parameters. ROC analysis demonstrated that RVOT-FS is a reliable parameter for predicting PH, with an area under the curve (AUC) of 0.866. An RVOT-FS value of 44.05% had a sensitivity of 82.7% and specificity of 83.3% for diagnosing PH. This study revealed that RVOT-FS was significantly lower in the PH group than in the control group. The correlations also observed between RVOT-FS and mPAP, PVR, and other RHC and echocardiographic parameters imply its potential clinical utility.

Hinderks, M. J.; Sliwicka, O.; Salah, K.; Sechopoulos, I.; Brink, M.; Cetinyurek-Yavuz, A.; Prokop, W. M.; Nijveldt, R.; Habets, J.; Damman, P.

doi: 10.1007/s10554-024-03292-8pmid: 39641891

Coronary CT angiography (CCTA) and dynamic stress CT myocardial perfusion (CT-MPI) are established modalities in the analysis of patients with chronic coronary syndromes. Their role in patients with suspected non-ST elevation myocardial infarction (NSTEMI) is unknown. CCTA with CT-MPI might assist in the triage of NSTEMI patients to the Cath lab. We investigated the correlation of significant epicardial lesions by CT-MPI in addition to CCTA compared to invasive coronary angiography (ICA) with fractional flow reserve (FFR) in patients with NSTEMI. Twenty NSTEMI patients scheduled for ICA were enrolled in this study with planned ICA. CCTA and CT-MPI was performed pre-ICA. For each coronary artery, the presence or absence of significant lesions was interpreted by CCTA with CT-MPI, using an FFR of ≤ 0.8 or angiographic culprit (stenosis > 90%, suspected plaque rupture) as reference. The main outcome was the per-vessel correlation. Sixteen out of 20 patients had a culprit lesion that required immediate revascularization. CCTA with ≥ 50% stenosis demonstrated a per vessel sensitivity and specificity for the detection of significant stenosis of respectively 100% (95% CI: 86–100%) and 75% (95% CI: 58–88%). CCTA with CT-MPI showed a lower sensitivity 90% (95% CI: 70–99%) but higher specificity of 100% (95% CI: 90–100%). CCTA with CT-MPI exhibits a strong correlation for identifying significant CAD in patients with NSTEMI. Thereby, it might assist in the triage of ICA in NSTEMI patients.