Coronary computed tomographic angiography allows direct evaluation of the vessel wall and thus positive remodeling, which is a marker of vulnerability. The purpose of this study was to assess the... Show moreCoronary computed tomographic angiography allows direct evaluation of the vessel wall and thus positive remodeling, which is a marker of vulnerability. The purpose of this study was to assess the association between positive remodeling on computed tomography angiogram (CTA) and vulnerable plaque characteristics on virtual histologic intravascular ultrasound (VH IVUS) images. Forty-five patients (78% men, 58 +/- 11 years old) underwent computed tomographic angiography followed by VH IVUS. On CIA, the remodeling index was determined for each lesion by a blinded observer using quantitative analysis. Positive remodeling was defined based on a remodeling index >= 1.0. Percent necrotic core and presence of thin-capped fibroatheroma (TCFA) were used as markers for plaque vulnerability on VH IVUS images. Ninety-nine atherosclerotic plaques were evaluated, of which 37 lesions (37.4%) were identified as having positive remodeling on CTA. Higher levels of plaque vulnerability were identified in lesions with positive remodeling compared to lesions without positive remodeling. Percent necrotic core was significantly higher in lesions with positive remodeling (15.7 +/- 7.8%) compared to lesions without this characteristic (10.2 +/- 7.2%, p <0.001). Furthermore, significantly more TCFA lesions were identified in positively remodeled lesions (n = 16, 43.2%) than in lesions without positive remodeling (n = 3, 4.8%, p <0.001). In conclusion, lesions with positive remodeling on CIA are associated with increased levels of plaque vulnerability on VH IVUS images including a higher percent necrotic core and a higher prevalence of TCFA. Thus evaluation of remodeling on CTA may provide a valuable marker for plaque vulnerability. (C) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;107:1725-1729) Show less
Veltman, C.E.; Boogers, M.J.; Chen, J.; Delgado, V.; Bommel, R.J. van; Hiel, B. van der; ... ; Bax, J.J. 2011
OBJECTIVES This study aimed to demonstrate the feasibility of multidetector row computed tomography (CT) for assessment of diastolic function in comparison with 2-dimensional (2D) echocardiography... Show moreOBJECTIVES This study aimed to demonstrate the feasibility of multidetector row computed tomography (CT) for assessment of diastolic function in comparison with 2-dimensional (2D) echocardiography using tissue Doppler imaging (TDI). BACKGROUND Diastolic left ventricular (LV) function plays an important role in patients with cardiovascular disease. 2D echocardiography using TDI has been used most commonly to evaluate diastolic LV function. Although the role of cardiac CT imaging for evaluation of coronary atherosclerosis has been explored extensively, its feasibility to evaluate diastolic function has not been studied. METHODS Patients who had undergone 64-multidetector row CT and 2D echocardiography with TDI were enrolled. Diastolic function was evaluated using early (E) and late (A) transmitral peak velocity (cm/s) and peak mitral septal tissue velocity (Ea; cm/s). Peak transmitral velocity (cm/s) was calculated by dividing peak diastolic transmitral flow (ml/s) by the corresponding mitral valve area (cm(2)). Mitral septal tissue velocity was calculated from changes in LV length per cardiac phase. Subsequently, the estimation of LV filling pressures (E/Ea) was determined. RESULTS Seventy patients (46 men; mean age 55 +/- 11 years) who had undergone cardiac CT and 2D echocardiography with TDI were included. Good correlations were observed between cardiac CT and 2D echocardiography for assessment of E (r = 0.73; p < 0.01), E/A (r = 0.87; p < 0.01), Ea (r = 0.82; p < 0.01), and E/Ea (r = 0.81; p < 0.01). Moreover, a good diagnostic accuracy (79%) was found for detection of diastolic dysfunction using cardiac CT. Finally, the study showed a low intraobserver and interobserver variability for assessment of diastolic function on cardiac CT. CONCLUSIONS Cardiac CT imaging showed good correlations for transmitral velocity, mitral septal tissue velocity, and estimation of LV filling pressures when compared with 2D echocardiography. Additionally, cardiac CT and 2D echocardiography were comparable for assessment of diastolic dysfunction. Accordingly, cardiac CT may provide information on diastolic dysfunction. (J Am Coll Cardiol Img 2011;4:246-56) (C) 2011 by the American College of Cardiology Foundation Show less
Aims The positive predictive value of multidetector computed tomography angiography (CTA) for detecting significant stenosis remains limited. Possibly CTA may be more accurate in the evaluation of... Show moreAims The positive predictive value of multidetector computed tomography angiography (CTA) for detecting significant stenosis remains limited. Possibly CTA may be more accurate in the evaluation of atherosclerosis rather than in the evaluation of stenosis severity. However, a comprehensive assessment of the diagnostic performance of CTA in comparison with both conventional coronary angiography (CCA) and intravascular ultrasound (IVUS) is lacking. Therefore, the aim of the study was to systematically investigate the diagnostic performance of CTA for two endpoints, namely detecting significant stenosis (using CCA as the reference standard) vs. detecting the presence of atherosclerosis (using IVUS as the reference of standard). Methods and results A total of 100 patients underwent CTA followed by both CCA and IVUS. Only those segments in which IVUS imaging was performed were included for CTA and quantitative coronary angiography (QCA) analysis. On CTA, each segment was evaluated for significant stenosis (defined as >= 50% luminal narrowing), on CCA significant stenosis was defined as a stenosis >= 50%. Second, on CTA, each segment was evaluated for atherosclerotic plaque; atherosclerosis on IVUS was defined as a plaque burden of >= 40% cross-sectional area. CTA correctly ruled out significant stenosis in 53 of 53 (100%) patients. However, nine patients (19%) were incorrectly diagnosed as having significant lesions on CTA resulting in sensitivity, specificity, positive, and negative predictive values of 100, 85, 81, and 100%. CTA correctly ruled out the presence of atherosclerosis in 7 patients (100%) and correctly identified the presence of atherosclerosis in 93 patients (100%). No patients were incorrectly classified, resulting in sensitivity, specificity, positive, and negative predictive values of 100%. Conclusions The present study is the first to confirm using both CCA and IVUS that the diagnostic performance of CTA is superior in the evaluation of the presence or the absence of atherosclerosis when compared with the evaluation of significant stenosis. Show less
Boogers, M.J.; Chen, J.; Bommel, R.J. van; Borleffs, C.J.W.; Dibbets-Schneider, P.; Hiel, B. van der; ... ; Bax, J.J. 2011
PURPOSE The aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV... Show morePURPOSE The aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead position and response to cardiac resynchronization therapy (CRT). METHODS The patient population consisted of consecutive patients with advanced heart failure in whom CRT was currently indicated. Before implantation, 2-D echocardiography and GMPS were performed. The echocardiography was performed to assess LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). The site of latest mechanical activation was assessed by phase analysis of GMPS studies and related to LV lead position on fluoroscopy. Echocardiography was repeated after 6 months of CRT. CRT response was defined as a decrease of ≥15% in LVESV. RESULTS Enrolled in the study were 90 patients (72% men, 67±10 years) with advanced heart failure. In 52 patients (58%), the LV lead was positioned at the site of latest mechanical activation (concordant), and in 38 patients (42%) the LV lead was positioned outside the site of latest mechanical activation (discordant). CRT response was significantly more often documented in patients with a concordant LV lead position than in patients with a discordant LV lead position (79% vs. 26%, p<0.01). After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p<0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables. CONCLUSION Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements. Show less
Boogers, M.J.; Chen, J.; Bommel, R.J. van; Borleffs, C.J.W.; Dibbets-Schneider, P.; Hiel, B. van der; ... ; Bax, J.J. 2011
The aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead... Show moreThe aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead position and response to cardiac resynchronization therapy (CRT). The patient population consisted of consecutive patients with advanced heart failure in whom CRT was currently indicated. Before implantation, 2-D echocardiography and GMPS were performed. The echocardiography was performed to assess LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). The site of latest mechanical activation was assessed by phase analysis of GMPS studies and related to LV lead position on fluoroscopy. Echocardiography was repeated after 6 months of CRT. CRT response was defined as a decrease of a parts per thousand yen15% in LVESV. Enrolled in the study were 90 patients (72% men, 67 +/- 10 years) with advanced heart failure. In 52 patients (58%), the LV lead was positioned at the site of latest mechanical activation (concordant), and in 38 patients (42%) the LV lead was positioned outside the site of latest mechanical activation (discordant). CRT response was significantly more often documented in patients with a concordant LV lead position than in patients with a discordant LV lead position (79% vs. 26%, p < 0.01). After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p < 0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables. Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements. Show less
Aims The aim of the present study was to evaluate whether subclinical left ventricular (LV) systolic dysfunction is independently related to subclinical coronary atherosclerosis in type 2 diabetic... Show moreAims The aim of the present study was to evaluate whether subclinical left ventricular (LV) systolic dysfunction is independently related to subclinical coronary atherosclerosis in type 2 diabetic patients and if it could provide incremental information over baseline characteristics to identify high-risk patients. Methods and results A total of 234 asymptomatic, type 2 diabetic patients without overt LV systolic dysfunction underwent coronary artery calcium (CAC) scoring and two-dimensional echocardiography. The LV global longitudinal strain (GLS) was assessed using automated function imaging. Patients with coronary atherosclerosis (CAC. 0; n = 139) had more impaired GLS when compared with patients without coronary atherosclerosis (CAC = 0; n = 95; -18.0 +/- 2.8 vs. -16.3 +/- 3.0%, P<0.001). At multivariate analysis, male gender, hypertension, hypercholesterolaemia, and the LV GLS were independently associated with coronary atherosclerosis. The addition of the LV GLS to other selected independent clinical variables significantly improved the ability to predict coronary atherosclerosis in these patients (chi(2) = 58.92; P = 0.001). Conclusion Type 2 diabetic patients with coronary atherosclerosis showed a more impaired LV GLS compared with patients without coronary atherosclerosis. The presence of subclinical LV systolic dysfunction provides significant incremental value for the identification of diabetic patients having coronary atherosclerosis. Show less
Diabetic heart disease is currently defined as left ventricular dysfunction that occurs independently of coronary artery disease and hypertension Its underlying etiology is likely to be... Show moreDiabetic heart disease is currently defined as left ventricular dysfunction that occurs independently of coronary artery disease and hypertension Its underlying etiology is likely to be multifactorial, acting synergistically together to cause myocardial dysfunction Multimodality cardiac imaging, such as echocardiography, nuclear, computed tomography, and magnetic resonance imaging, can provide invaluable insight into different aspects of the disease process, from imaging at the cellular level for altered myocardial metabolism to microvascular and endothelial dysfunction, autonomic neuropathy, coronary atherosclerosis, and finally, interstitial fibrosis with scar formation Furthermore, cardiac imaging is pivotal in diagnosing diabetic heart disease Thus, the aim of the present review is to illustrate the role of multimodality cardiac imaging in elucidating the underlying pathophysiologic mechanisms of diabetic heart disease (Curr Probl Cardiol 2011,36 9-47) Show less
The purpose of this study was to determine the prognostic value of computed tomography coronary angiography (CTA)-derived left ventricular (LV) function analysis and to assess its incremental... Show moreThe purpose of this study was to determine the prognostic value of computed tomography coronary angiography (CTA)-derived left ventricular (LV) function analysis and to assess its incremental prognostic value over the detection of significant stenosis using CTA. In 728 patients (400 males, mean age 55 +/- A 12 years) with known or suspected CAD, the presence of significant stenosis (a parts per thousand yen 50% stenosis) and LV function were assessed using CTA. LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), and LV ejection fraction (LVEF) were calculated. LV function was assessed as a continuous variable and using cutoff values (LVEDV > 215 mL, LVESV > 90 mL, LVEF < 49%). The following events were combined in a composite end-point: all-cause mortality, non-fatal myocardial infarction, and unstable angina pectoris requiring hospitalization. On CTA, a significant stenosis was observed in 221 patients (30%). During follow-up [median 765 days, 25-75th percentile: 493-978] an event occurred in 45 patients (6.2%). After multivariate correction for clinical risk factors and CTA, LVEF < 49% and LVESV > 90 mL were independent predictors of events with an incremental prognostic value over clinical risk factors and CTA. The present results suggest that LV function analysis provides independent and incremental prognostic information beyond anatomic assessment of CAD using CTA. Show less
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