Feasibility of a MPR-based 3DTEE guidance protocol for transcatheter direct mitral valve annuloplasty.
Objectives Several interventional approaches have been established for the treatment of severe mitral regurgitation (MR) in patients at elevated risk for surgery. Direct annuloplasty is a relatively novel option in transcatheter mitral valve repair dedicated to reverse pathology in specific subsets of MR. With regard to echocardiographic guidance, this procedure presents with higher efforts in comparison with edge-to-edge therapy to enable safe and exact positioning of the device's anchors; evidence on optimal peri-interventional imaging is sparse. We tested a specific 3D-echo-guidance protocol implementing single-beat multiplanar reconstruction (MPR) and evaluated its feasibility. Methods …
Multicenter Consistency Assessment of Valvular Flow Quantification With Automated Valve Tracking in 4D Flow CMR
OBJECTIVES This study determined: 1) the interobserver agreement; 2) valvular flow variation; and 3) which variables independently predicted the variation of valvular flow quantification from 4-dimensional (4D) flow cardiac magnetic resonance (CMR) with automated retrospective valve tracking at multiple sites. BACKGROUND Automated retrospective valve tracking in 4D flow CMR allows consistent assessment of valvular flow through all intracardiac valves. However, due to the variance of CMR scanners and protocols, it remains uncertain if the published consistency holds for other clinical centers. METHODS Seven sites each retrospectively or prospectively selected 20 subjects who underwent whole …
Letter: coronary atherosclerosis in patients with significant hepatic fibrosis in non‐alcoholic fatty liver disease—the role for non‐invasive testing
Advanced Protocol for Three-Dimensional Transesophageal Echocardiography Guidance Implementing Real-Time Multiplanar Reconstruction for Transcatheter Mitral Valve Repair by Direct Annuloplasty.
Transcatheter direct annuloplasty has been introduced as a novel interventional treatment option for severe mitral valve regurgitation. Until now, only one direct annuloplasty device (Edwards Cardioband) has been commercially available, being implanted in more than 250 patients worldwide. Yet this procedure poses greater challenges regarding optimal fluoroscopic and echocardiographic guidance compared with edge-to-edge repair: correct localization and orientation of the anchors upon penetration into the fibrous mitral annulus tissue and the basal left ventricular myocardium are preconditions for an optimal result and essential to avoid damage of the neighboring structures (atrioventricular …
Coronary plaque assessment of Vasodilative capacity by CT angiography effectively estimates fractional flow reserve.
Abstract Background To evaluate the feasibility of non-invasive fractional flow reserve (FFR) estimation using histologically-validated assessment of plaque morphology on coronary CTA (CCTA) as inputs to a predictive model further validated against invasive FFR. Methods Patients (n = 113, 59 ± 8.9 years, 77% male) with suspected coronary artery disease (CAD) who had undergone CCTA and invasive FFR between August 2013 and May 2018 were included. Commercially available software was used to extract quantitative plaque morphology inclusive of both vessel structure and composition. The extracted plaque morphology was then fed as inputs to an optimized artificial neural network to predict lesion-…
Multidetector Computed Tomography Angiography (MD-CTA) of Coronary Artery Bypass Grafts – Update 2017
Coronary artery bypass grafting (CABG) is still an important therapeutic approach in the treatment especially of advanced coronary artery disease. In this study, we elucidate the current role of multidetector computed tomography angiography (MD-CTA) in imaging patients after CABG surgery.This study is based on recent reports in the literature (2007 - 2016) on imaging of CABG using 64-slice MD-CT scanners and beyond. We included 13 reports that compared ECG-gated MD-CTA with conventional invasive coronary angiography (ICA) as the reference standard for the assessment of graft patency and for the detection of 50 % stenoses. These studies had to provide absolute values for true-positive, true-…
Dynamic contrast‐enhanced magnetic resonance imaging for monitoring angiogenesis during bone regeneration – a randomized pilot study in rabbits
How COVID-19 kick-started online learning in medical education-The DigiMed study.
Background The coronavirus disease 2019 (COVID-19) pandemic led to far-reaching restrictions of social and professional life, affecting societies all over the world. To contain the virus, medical schools had to restructure their curriculum by switching to online learning. However, only few medical schools had implemented such novel learning concepts. We aimed to evaluate students’ attitudes to online learning to provide a broad scientific basis to guide future development of medical education. Methods Overall, 3286 medical students from 12 different countries participated in this cross-sectional, web-based study investigating various aspects of online learning in medical education. On a 7-…
Progression of transthyretin (TTR) amyloidosis in donors and recipients after domino liver transplantation-a prospective single-center cohort study
Liver transplantation (LT) is the first-line therapy in patients with transthyretin (TTR) amyloidosis and progressive familial amyloid polyneuropathy (FAP). Explanted organs from these patients can be used for domino liver transplantation (DLT). After DLT, de novo amyloidosis may develop in domino recipients (DR). Data were collected prospectively in a transplant database. Electroneurography by nerve conduction velocity (NCV), quantitative sensory testing, heart rate variability (HRV), sympathetic skin response, orthostatic reaction (tilt table test), transthoracic echocardiography, cardiac MRI and organ biopsy results were evaluated. The cohort included 24 FAP- (11 Val30Met, 13 nonVal30Met…
Computed tomography imaging needs for novel transcatheter tricuspid valve repair and replacement therapies
Abstract Transcatheter tricuspid valve therapies are an emerging field in structural heart interventions due to the rising number of patients with severe tricuspid regurgitation and the high risk for surgical treatment. Computed tomography (CT) allows exact measurements of the annular plane, evaluation of adjacent structures, assessment of the access route, and can also be used to identify optimal fluoroscopic projection planes to enhance periprocedural imaging. This review provides an overview of current transcatheter tricuspid valve repair and replacement therapies and to what extent CT can support these interventions.
Right/Left Ventricular Blood Pool T2 Ratio as an Innovative Cardiac MRI Screening Tool for the Identification of Left‐to‐Right Shunts in Patients With Right Ventricular Disease
Background Left-to-right (L-R) shunts are characterized by a pathological connection between high- and low-pressure systems, leading to a mixing of oxygen-rich blood with low oxygenated blood. They are typically diagnosed by phase-contrast cardiac magnetic resonance imaging (MRI) which requires extensive planning. T2 is sensitive to blood oxygenation and may be able to detect oxygenation differences between the left (LV) and right ventricles (RV) caused by L-R shunts. Purpose To test the feasibility of routine T2 mapping to detect L-R shunts. Study type Retrospective. Population Patients with known L-R shunts (N = 27), patients with RV disease without L-R shunts (N = 21), and healthy volunt…
Myocarditis in Relation to Angiographic Findings in Patients With Provisional Diagnoses of MINOCA
The aim of this study was to determine the prevalence of myocarditis among patients presenting with myocardial infarction with nonobstructive coronary arteries (MINOCA) in relation to the angiographic severity of nonobstructive coronary artery disease (CAD).MINOCA represents about 6% of all cases of acute myocardial infarction. Myocarditis is a diagnosis that may be identified by cardiac magnetic resonance (CMR) imaging in patients with a provisional diagnosis of MINOCA.A systematic review was performed to identify studies reporting the results of CMR findings in MINOCA patients with nonobstructive CAD or normal coronary arteries. Study-level and individual patient data meta-analyses were p…
Myocardial Mass Corrected CMR Feature Tracking-Based Strain Ratios are Different in Pathologies With Increased Myocardial Mass
Acute myocarditis (AM) and hypertensive heart disease (HHD) have different pathophysiological backgrounds, thus potentially showing distinct patterns of altered myocardial deformation. Therefore, CMR left ventricular (LV) feature tracking (FT)- based strain parameters were indexed to myocardial mass index (LVMi) in order to evaluate potential additional value in the differentiation among AM, HHD, and healthy volunteers (HV) compared to non-indexed conventional strain.Patients with AM (n = 43) and HHD (n = 28) underwent CMR at 3T. 61 HV served as controls. Cine imaging-based FT-strain analysis was performed and natural strain (nStrain) values were evaluated for gender and age specific differ…
Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries
To assess the diagnostic value of cardiac MRI (CMR) in patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram.This study included a total of 125 patients treated in the chest pain unit during a 39-month period. Each included patient underwent MRI within a median of 3 days after cardiac catheterization. The MRI protocol comprised cine, oedema-sensitive and late gadolinium-enhancement imaging. The standard of reference was a consensus diagnosis based on clinical follow-up and the synopsis of all clinical, laboratory and imaging data.MRI revealed a multitude of diagnoses, including ischaemic cardiomyopathy (CM), dilated CM, myocarditis, Takotsubo CM, hyperte…