Journal of Cardiovascular Computed Tomography

TAVI Major

This record contains raw data related to the article “Quantification of extracellular volume with cardiac computed tomography in patients with dilated cardiomyopathy” Background: Cardiac computed tomography (CCT) was recently validated to measure extracellular volume (ECV) in the setting of cardiac amyloidosis, showing good agreement with cardiovascular magnetic resonance (CMR). However, no evidence is available with a whole-heart single source, single energy CT scanner in the clinical context of newly diagnosed left ventricular dysfunction. Therefore, the aim of this study was to test the diagnostic accuracy of ECVCCT in patients with a recent diagnosis of dilated cardiomyopathy, having ECVCMR as the reference technique. Methods: 39 consecutive patients with newly diagnosed dilated cardiomyopathy (LVEF <50%) scheduled for clinically indicated CMR were prospectively enrolled. Myocardial segment evaluability assessment with each technique, agreement between ECVCMR and ECVCCT, regression analysis, Bland-Altman analysis and interclass correlation coefficient (ICC) were performed. Results: Mean age of enrolled patients was 62 11 years, and mean LVEF at CMR was 35.4 10.7%. Overall radiation exposure for ECV estimation was 2.1 1.1 mSv. Out of 624 myocardial segments available for analysis, 624 (100%) segments were assessable by CCT while 608 (97.4%) were evaluable at CMR. ECVCCT demonstrated slightly lower values compared to ECVCMR (all segments, 31.8 6.5% vs 33.9 8.0%, p < 0.001). At regression analysis, strong correlations were described (all segments, r ¼ 0.819, 95% CI: 0.791 to 0.844). On Bland-Altman analysis, bias between ECVCMR and ECVCCT for global analysis was 2.1 (95% CI: 6.8 to 11.1). ICC analysis showed both high intra-observer and inter-observer agreement for ECVCCT calculation (0.986, 95%CI: 0.983 to 0.988 and 0.966, 95%CI: 0.960 to 0.971, respectively). Conclusions: ECV estimation with a whole-heart single source, single energy CT scanner is feasible and accurate. Integration of ECV measurement in a comprehensive CCT evaluation of patients with newly diagnosed dilated cardiomyopathy can be performed with a small increase in overall radiation exposure.

This record contains raw data related to the article "Identification of subclinical cardiac amyloidosis in aortic stenosis patients undergoing transaortic valve replacement using radiomic analysis of computed tomography myocardial texture" Background. Cardiac amyloidosis (CA) is an increasingly diagnosed disease sharing several phenotypical features with aortic stenosis (AS). Purpose. As diagnosing the two diseases has crucial prognostic and therapeutic implications, this study aims to identify a set Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation of stable and discriminative radiomic features derived from cardiac computed tomography to differentiate them. Methods: Forty-two patients were included in the study. For each patient, 107 radiomics features were evaluated by means of geometrical transformations (translations) to the region of interests (ROIs) and intra class correlation coefficient (ICC) computation. A stratified 7-fold cross (k=7) validation was performed to split data into learning, validation and test set. Three features selection methods (Wilcoxon signed rank-based method and/or LASSO regression) and five machine learning classifiers. Results: Ninety radiomic features satisfied robustness criteria and 10 were kept after feature selection. The best results were obtained using logistic regression classifier combined with Wilcoxon signed rank and LASSO regression, obtaining an accuracy of 95 ± 7% and sensitivity and specificity equal to 95 ± 12% in the test set. Conclusions: the application of radiomics shows promising results in distinguishing left ventricle hypertrophy caused by CA from AS and might be used as a non-invasive tool able to support clinical decision making.

This record contains raw datarelated to the article"Diagnostic accuracy of subendocardial vs. transmural myocardial perfusion defect for the detection of in-stent restenosis or progression of coronary artery disease after percutaneous coronary intervention Background. The ADVANTAGE study demonstrated in a cohort of stented patients a diagnostic accuracy of stress myocardial CT perfusion (CTP) significantly higher than that of coronary CT angiography (CCTA) for the detection of in-stent restenosis (ISR) or CAD progression vs. quantitative coronary angiography (QCA). This is a pre-defined subanalysis of the ADVANTAGE aimed at assessing the difference in terms of diagnostic accuracy vs. QCA of a subendocardial vs. a transmural perfusion defect using static stress CTP. Methods. We enrolled consecutive patients who previously underwent coronary stenting and were referred for QCA. All patients underwent stress CTP and rest CTP+CCTA. The diagnostic accuracy of CCTA and CTP were evaluated in territory-based and patient-based analyses. We compared the diagnostic accuracy of “subendocardial” perfusion defect, defined as hypo-enhancement encompassing >25% but <50% of the transmural myocardial thickness within a specific coronary territory vs. “transmural” perfusion defect, defined as hypo-enhancement encompassing >50% of the transmural thickness. Results. In 150 patients (132 men, mean age 65.1±9.1 years), the diagnostic accuracy of subendocardial vs. transmural perfusion defect in a vessel-based analysis was 93.5% vs. 87.7%, respectively (p<0.0001). The sensitivity and specificity of subendocardial vs. transmural defect were 87.9% vs. 46.9% (p<0.001) and 94.9% vs. 97.9% (p=0.004), respectively. In a patient-based analysis, the diagnostic accuracy of the subendocardial vs. transmural approach was 86.6% vs. 68% (p<0.0001). Conclusions. This study shows that detection of a subendocardial perfusion defect as compared to a transmural defect is significantly more accurate to identify coronary territories with ISR or CAD progression.

This record contains raw data related to the article: Interpretability of coronary CT angiography performed with a novel wholeheart coverage high-definition CT scanner in 300 consecutive patients with coronary artery bypass grafts' Aims: Coronary CT angiography (CCTA) is an accurate non-invasive tool for the evaluation of coronary artery bypass graft (CABG). However, inability to sustain a long breath-hold, high heart rate (HR) and atrial fibrillation may affect image quality. Moreover, radiation exposure is still a matter of some concern. A scanner combining 0.23-mm spatial resolution, new iterative reconstruction and fast gantry rotation time has been recently introduced in the clinical field. The aims of our study were to evaluate interpretability, radiation exposure and diagnostic accuracy of CCTA performed with the latest generation of cardiac-CT scanners compared to invasive coronary angiography (ICA) in the assessment of bypass grafts, and non-grafted and post-anastomotic native coronary arteries. Methods and results: We prospectively enrolled 300 patients undergoing clinically indicated CCTA with a 16-cm z-axis coverage, 256-detector rows, and 0.28-sec gantry rotation time scanner. Coronary artery and graft interpretability, image quality and effective dose (ED) were assessed in all patients and diagnostic accuracy was evaluated in a subgroup of 100 patients who underwent ICA. Mean HR during the scan was 69.6 ± 10.8. Sinus rhythm was present in 118 patients with HR < 75 bpm and in 112 patients with HR≥75 bpm, while 70 patients had atrial fibrillation. CABG interpretability was 100%. Compared to ICA, CCTA was able to correctly detecting occlusions or significant stenoses of all CABG segments. Overall interpretability of native coronary segments was 95.6%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of coronary arteries were 98.3%, 97.4%, 93.1%, 99.3% and 96.5%, respectively. The diagnostic accuracy in a patient based analysis was 95.2%. Mean ED was 3.14 ± 1.7 mSv. Conclusions: The novel whole-heart coverage CT scanner allows to evaluating CABG and native coronary arteries with excellent interpretability and low radiation exposure even in the presence of unfavorable heart rhythm.