The relationship between coronavirus disease-19(COVID-19)and cardiovascular diseases has been an important issue.Therefore,cardiac biomarkers and cardiac imaging have an important place in the diagnostic phase.It is i...The relationship between coronavirus disease-19(COVID-19)and cardiovascular diseases has been an important issue.Therefore,cardiac biomarkers and cardiac imaging have an important place in the diagnostic phase.It is important to know the relationship of biomarkers in COVID-19 so that we can understand the diagnosis of the disease,the predicted course and results after diagnosis.展开更多
AIM:To investigate diagnostic accuracy of high,low and mixed voltage dual energy computed tomography(DECT) for detection of prior myocardial infarction(MI).METHODS:Twenty-four consecutive patients(88% male,mean age 65...AIM:To investigate diagnostic accuracy of high,low and mixed voltage dual energy computed tomography(DECT) for detection of prior myocardial infarction(MI).METHODS:Twenty-four consecutive patients(88% male,mean age 65 ± 11 years old) with clinically documented prior MI(】 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI.Computed tomography(CT) examinations were performed using a dual source CT system(64-slice Definition or 128-slice Definition FLASH,Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions.Using the 17-segment model,regional systolic function was analyzed using first pass CT as normal or abnormal(hypokinetic,akinetic,dyskinetic).Regions with abnormal systolic function were identified as infarct segments.Late phase DE scans were reconstructed into:140 kVp,100 kVp,mixed(120 kVp) images and iodine-only datasets.Using the same 17-segment model,each dataset was evaluated for possible(grade 2) or definite(grade 3) late phase myocardial enhancement abnormalities.Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores.RESULTS:All patients reported prior history of documented myocardial infarction,with most occurring more than 5 years prior(n = 18;75% of cohort).Fiftyfive of 408(13%) segments demonstrated abnormal wall motion and were classified as infarct.The remaining 353 segments were classified as non-infarcted segments.A total of 1692 segments were analyzed for late phase enhancement abnormalities,with 91(5.5%) segments not interpretable due to artifact.Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated.Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy(87%;95%CI:80%-90%),sensitivity(86%-93%;95%CI:54%-78%) and specificity(90%;95%CI:86%-93%) compared to the other reconstructions.For sensitivity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.0005),100 kVp vs mixed(P【0.0001),and 100 kVp vs iodine only(P【0.005) using combined grade 2 and grade 3 perfusion abnormalities.For specificity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.005),and 100 kVp vs mixed(P【0.01) using combined grades 2 and 3 perfusion abnormalities.CONCLUSION:Low voltage acquisition CT,100 kVp in this study,demonstrates superior diagnostic performance when compared to higher and mixed voltage acquisitions for detection of prior MI.展开更多
For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-ter...For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.展开更多
文摘The relationship between coronavirus disease-19(COVID-19)and cardiovascular diseases has been an important issue.Therefore,cardiac biomarkers and cardiac imaging have an important place in the diagnostic phase.It is important to know the relationship of biomarkers in COVID-19 so that we can understand the diagnosis of the disease,the predicted course and results after diagnosis.
基金Supported by Grant from the Agency for Healthcare Research and Quality,No.K12HS019473
文摘AIM:To investigate diagnostic accuracy of high,low and mixed voltage dual energy computed tomography(DECT) for detection of prior myocardial infarction(MI).METHODS:Twenty-four consecutive patients(88% male,mean age 65 ± 11 years old) with clinically documented prior MI(】 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI.Computed tomography(CT) examinations were performed using a dual source CT system(64-slice Definition or 128-slice Definition FLASH,Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions.Using the 17-segment model,regional systolic function was analyzed using first pass CT as normal or abnormal(hypokinetic,akinetic,dyskinetic).Regions with abnormal systolic function were identified as infarct segments.Late phase DE scans were reconstructed into:140 kVp,100 kVp,mixed(120 kVp) images and iodine-only datasets.Using the same 17-segment model,each dataset was evaluated for possible(grade 2) or definite(grade 3) late phase myocardial enhancement abnormalities.Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores.RESULTS:All patients reported prior history of documented myocardial infarction,with most occurring more than 5 years prior(n = 18;75% of cohort).Fiftyfive of 408(13%) segments demonstrated abnormal wall motion and were classified as infarct.The remaining 353 segments were classified as non-infarcted segments.A total of 1692 segments were analyzed for late phase enhancement abnormalities,with 91(5.5%) segments not interpretable due to artifact.Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated.Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy(87%;95%CI:80%-90%),sensitivity(86%-93%;95%CI:54%-78%) and specificity(90%;95%CI:86%-93%) compared to the other reconstructions.For sensitivity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.0005),100 kVp vs mixed(P【0.0001),and 100 kVp vs iodine only(P【0.005) using combined grade 2 and grade 3 perfusion abnormalities.For specificity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.005),and 100 kVp vs mixed(P【0.01) using combined grades 2 and 3 perfusion abnormalities.CONCLUSION:Low voltage acquisition CT,100 kVp in this study,demonstrates superior diagnostic performance when compared to higher and mixed voltage acquisitions for detection of prior MI.
基金Supported by Zhejiang Provincial Foundation for Medical and Health Sciences,No.2021KY980.
文摘For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.
