An 82‐year‐old woman with precordial pain at rest was admitted to the Emergency Department for possible cardiac heart disease; electrocardiogram excluded ischemia and high‐sensitive troponin was ...normal. Echocardiogram revealed a hyperechoic mass adjacent to the mitral annulus. Electrocardiography‐gated computed tomography (CT) angiography exam confirmed the presence of the mass protruding into the atrioventricular groove, adjacent to the posterior mitral. On the precontrast images the lesion was hyperdense with some scattered central calcific spots. CT findings are typical of a giant caseous calcification of the mitral annulus and excluded the diagnoses of pseudoaneurysm (it does not show any communication with the left ventricular cavity), neoplasm/abscess (complete caseous/calcified content) or infected/abscessified mitral calcification (absence of internal hypodense core). This is a benign condition that can be easily misdiagnosed as ventricular aneurysm or pseudoaneurysm on the contrast‐enhanced images, when the caseous content is isodense to the iodinated blood pool.
Aim of the study is to compare manual and semi-automatic measurements for aortic annulus assessment among different operators.
80 patients that underwent TAVI were retrospectively enrolled. The ...measurements manually performed by an experienced reader for aortic annulus (minimum and maximum diameters, perimeter, area), annulus-to-coronary ostia distance and time needed for the whole evaluation, were collected. The same operator (observer1) and two less experienced readers (observer2 and 3, with >5 years and 1 year of experience respectively) assessed the same measurements using a semi-automatic software. Differences between manual and semi-automatic measurements, reading time and suggested valves size derived by CT were compared.
Very good correlations were found between manual and software-aided measurements for aortic annulus area and perimeter in comparison with standard measurements for the three readers (ICC range 0.81-0.98). Good correlations were found for the distance with coronary ostia(0.75-0.79). The same area-derived prosthesis size for manual and semi-automatic measurements was selected in 96% of cases for observer 1; very good correlations were also found for observer 2 and 3 (ICC = 0.89 and 0.88 respectively). Using semi-automatic measurements the mean time needed for CT images was significantly lower for observer 1 and 2 (1.50 and 1.72versus 3.14 min respectively.
Pre-TAVI CT using semi-automatic software allows accurate and reproducible measurements, reducing reconstruction time up to 50% and is reliable even for operators with different experience.
The use of semi-automatic dedicated software for CT in TAVI planning is reliable even for operators without long time experience and allows accurate and reproducible measurements improving pre-TAVI workflow.
We aimed to investigate the role of feature-tracking (FT) strain in long-term risk stratification of patients with known or suspected coronary artery disease (CAD) who underwent stress cardiac MRI ...with dipyridamole; to determine if contrast-free stress cardiac MRI with strain measurements could provide comparable prognostic value to myocardial perfusion.
This retrospective study included consecutive patients with stable symptoms suggesting possible cardiac ischemia who underwent stress cardiac MRI with dipyridamole. The mean follow-up period was 5.8 years ±1.2 SD. FT cardiac MRI analysis was performed for each patient to obtain 2D global peak circumferential strain (GCS). The primary outcome measure was major adverse cardiac events (MACE), defined as nonfatal myocardial infarction and cardiac death.
A total of 729 patients (mean age, 63 years ±10 SD; 616 males) were included. MACE occurred in 70 (9.6%) patients. The presence of late gadolinium enhancement (LGE) (HR 2.74, 95% CI: 1.53, 4.88; P < .001) and stress GCS (HR, 1.06 95% CI: 1.01, 1.12; P = .016) were independently associated with MACE. A model based on contrast-free assessment of LVEF and stress GCS showed similar performance for predicting MACE than LVEF and perfusion (P = .056).
In patients with known or suspected CAD undergoing stress cardiac MRI with dipyridamole, GCS and LGE presence were independent predictors of MACE. Contrast-free stress cardiac MRI with stress GCS measurement offered prognostic value akin to myocardial perfusion assessment.
Stress global circumferential strain represented an additional method to predict major adverse cardiac events in patients undergoing stress cardiac MRI, even without the use of contrast agents. This would be of particular significance in patients with severe renal impairment.
•LGE and stress GCS are independent predictors of events in patients undergoing Stress MRI.•Stress GCS > 15% was associated with lower event-free survival than stress GCS ≤ 15%.•Contrast free stress MRI combined with stress GCS measurement provides prognostic information similar to myocardial perfusion evaluation.
This study investigated the additional prognostic value of epicardial adipose tissue (EAT) volume for major adverse cardiovascular events (MACE) in patients undergoing stress cardiac magnetic ...resonance (CMR) imaging.
730 consecutive patients mean age: 63 ± 10 years; 616 men who underwent stress CMR for known or suspected coronary artery disease were randomly divided into derivation (n = 365) and validation (n = 365) cohorts. MACE was defined as non-fatal myocardial infarction and cardiac deaths. A deep learning algorithm was developed and trained to quantify EAT volume from CMR. EAT volume was adjusted for height (EAT volume index). A composite CMR-based risk score by Cox analysis of the risk of MACE was created.
In the derivation cohort, 32 patients (8.7 %) developed MACE during a follow-up of 2103 days. Left ventricular ejection fraction (LVEF) < 35 % (HR 4.407 95 % CI 1.903–10.202; p<0.001), stress perfusion defect (HR 3.550 95 % CI 1.765–7.138; p<0.001), late gadolinium enhancement (LGE) (HR 4.428 95%CI 1.822–10.759; p = 0.001) and EAT volume index (HR 1.082 95 % CI 1.045–1.120; p<0.001) were independent predictors of MACE. In a multivariate Cox regression analysis, adding EAT volume index to a composite risk score including LVEF, stress perfusion defect and LGE provided additional value in MACE prediction, with a net reclassification improvement of 0.683 (95%CI, 0.336–1.03; p<0.001). The combined evaluation of risk score and EAT volume index showed a higher Harrel C statistic as compared to risk score (0.85 vs. 0.76; p<0.001) and EAT volume index alone (0.85 vs.0.74; p<0.001). These findings were confirmed in the validation cohort.
In patients with clinically indicated stress CMR, fully automated EAT volume measured by deep learning can provide additional prognostic information on top of standard clinical and imaging parameters.
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•EAT can be automatically and accurately quantified from standard CMR cine images using a new deep learning algorithm.•EAT volume index can predict MACE in patients undergoing stress CMR.•EAT volume index has an incremental prognostic role beyond standard clinical and imaging parameters.
Four-dimensional (4D) flow MRI has emerged as a powerful non-invasive technique in cardiovascular imaging, enabling to analyse in vivo complex flow dynamics models by quantifying flow parameters and ...derived features. Deep knowledge of aortic flow dynamics is fundamental to better understand how abnormal flow patterns may promote or worsen vascular diseases. In the perspective of an increasingly personalized and preventive medicine, growing interest is focused on identifying those quantitative functional features which are early predictive markers of pathological evolution. The thoracic aorta and its spectrum of diseases, as the first area of application and development of 4D flow MRI and supported by an extensive experimental validation, represents the ideal model to introduce this technique into daily clinical practice. The purpose of this review is to describe the impact of 4D flow MRI in the assessment of the thoracic aorta and its most common affecting diseases, providing an overview of the actual clinical applications and describing the potential role of derived advanced hemodynamic measures in tailoring follow-up and treatment.
Dear Editor, Eosinophilic myocarditis is a life-threatening complication of eosinophilic syndromes including eosinophilic granulomatosis with polyangiitis (EGPA), undefined complex hypereosinophilic ...syndrome (HES), and drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. The in-hospital death rate for eosinophilic myocarditis due to any cause is about 20%, and is as high as 50% in its acute necrotizing form associated with DRESS. Conventional therapies including high-dose glucocorticoids and other immunosuppressants have variable efficacy and substantial toxic effects. Dilated cardiomyopathy is a frightening sequela but its incidence is unknown. Recent studies investigated anti-interleukin 5 (mepolizumab) or anti-interleukin 5 receptor (benralizumab) monoclonal anti-bodies for the treatment of EGPA or HES.
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