Cardiac Imaging News

Risk for Abdominal Aortic Aneurysms Determined by Molecular Imaging…

Based on new research published in the October issue of The Journal of Nuclear Medicine, numerous nascent identified markers could offer worthy insight to forecast the risk of rupture abdominal aortic aneurysms (AAA). Imaging with positron emission tomography/computed tomography (PET/CT) has demonstrated that thick white blood cells in the outermost connective tissue in the vascular wall, increased C-reactive protein and a loss of smooth muscle cells in the middle layer of the vascular wall are all components that may allude to future AAA rupture. An abdominal aneurysm puts stress on the wall of the aorta, which can cause it to rupture. Rupture of AAA is the 13th leading cause of death in western society and leads to considerable morbidity and mortality in the aging population. AAA is normally asymptomatic, so the accurate prediction of rupture is vital to positively impact public health. In order to set potential markers that could be indicative of AAA rupture, the researchers performed 18F-FDG PET/CT scans on 18 patients with AAA initially diagnosed by ultrasound. Ten of the patients had no uptake of the 18F-FDG, while eight had positive uptake of the radiopharmaceutical. Biopsies were then taken from each of the patients; patients with positive 18F-FDG uptake had tissue removed from both the site of the positive uptake and a distant negative site of the aortic wall. "Our approach allows us for the first time to our knowledge to analyze spots of high 18F-FDG uptake and compare them to a distant inactive zone of the same aneurysm. We further compared these biopsies to fragments collected in patients with negative 18F-FDGuptake. This strategy allowed for the discrimination of biologic alterations associated with 18F-FDGuptake that would help identify relevant biologic markers predictive of rupture. 18F-FDG Uptake Assessed by PET/CT in Abdominal Aortic Aneurysms Is Associated with Cellular and Molecular Alterations Prefacing Wall Deterioration and Rupture,” said lead author of the study, Audrey Courtois, PhD. The tissue from the area of positive 18F-FDG uptake were catagorized by an increased number of inflammatory cells in the outermost connective tissue, a high level of C-reactive protein and a significant reduction in smooth muscle cells, as opposed to the biopsies from areas of no uptake. Moreover, an increase in several matrix metalloproteinases enzymes was noted in the tissue with positive 18F-FDG uptake. "These data suggest that a PET scan with positive 18F-FDG uptake provide diagnostic support to proceed without delay to aneurysm surgery, despite a person's age or operative risk. However, the absence of FDG uptake at the level of the aneurismal aortic wall can help us make a safe decision to avoid unnecessary surgery and decrease the burden of health care costs," said Courtois. "This 18F-FDG PET/CT study, with an arterial phase CT, allows us to fully characterize the disease, including the conventional risk factors such as the size of the aneurysm. Although much of the current research is being conducted in the field of oncology, the current study further strengthens 18F-FDG PET/CT as a decisive tool in the management of inflammatory disorders,” she ... Read more

FFR, iFR Detect Hemodynamic Changes Following PCI…

Immediate wave-free radio and fractional flow reserve showed identical abilities for detecting stenosis significance following percutaneous coronary intervention (PCI) in a study published in the journal Heart. Researchers conducted the potential ... Read more

MRI May Effectively Indicate CVD in Diabetics…

Researchers have discovered that by using whole body MRI, it is highly likely cardiovascular disease in patients with diabetes can be foretold. According to Fabian Bamberg, MD, MPH, of Ludwig-Maximilians University in Munich, and his team, patients who presented noticeable vascular changes on whole body MRI had a growing risk of a cardiovascular event of 20% at 3 years, and 35% at 6 years. However, none of the patients with a regular whole body MRI scan suffered from a cardiac event over that period of time as detailed in the study, published online in the journal Radiology. "Whole-body MRI may help in identifying patients who are at very high risk for future events and require intensified treatment or observation. Conversely, the absence of any changes on whole-body MRI may reassure diabetic patients that their risk for a heart attack, stroke, or other major cardiac or cerebrovascular event is low,” said Bamberg. It is a well known fact that patients who have a condition of diabetes are prone to cardiovascular disease. And of late, there has been a surge of supporting evidence that MRI can offer reliable predictive information on cardiovascular outcomes and events. Bamberg highlighted that the imaging system is in no way linked to radiation exposure, and has the ability to evaluate whole-body degree of disease burden that is not clinically apparent yet." In order to determine its prognostic worth in either case of type 1 or type 2 diabetes, the researchers registered 65 diabetic patients, who had a contrast-enhanced whole body MRI that included brain, cardiac, and vascular cycles. The main outcome was a combination of significant adverse cardiac and cerebrovascular events (MACCE) which included cardiac-cerebrovascular death, myocardial infarction, cerebrovascular event, or revascularization. And after an average follow-up period of 5.8 years, it was found that 23% of the patients experienced a MACCE event. Bamberg and his team discovered that patients with noticeable vascular changes on whole body MRI had a growing MACCE rate of 20% at 3 years and 35% at 6 years. However, those without any noticeable ischemic or atherosclerotic traces had no cardiovascular events over the duration of the study. "Our results showed that the absence of any finding at whole-body MR imaging excludes events during a relatively long follow-up period," they noted.   Single-bases analyses showed that patients who did experience an event had a greater incidence of findings at cardiac, carotid, and peripheral vessel imaging, not to mention higher whole body summary findings as opposed to those who did not experience an event. Yet they warned that analyses attuned to the history of cardiovascular disease discovered that only the existence of myocardial hypokinesis or akinesis with cardiac sequences (P=0.008), not to mention the summary measures (P=0.03 for the number of abnormal territories and P=0.01 for the vessel score), to still be considerably linked to events.  They also revealed that in further analyses these summarized calculations were constantly discovered to be strong indicators of MACCE, irrespective of demographics and history. •    Atherosclerotic vessel score: hazard ratio 12.0, 95% CI 2.5-67.3 •    Number of vascular territories with positive findings: HR 3.2, 95% CI 1.4-8.2 “These summary measures are strong predictors that appear to be incremental to established parameters such as the finding of hypokinesia or akinesia as detected at whole-body imaging," said Bamberg. However, researchers suggest that this single-center study does have its limitations. They noted that "the character of this study is hypothesis generating rather than allowing final conclusions," however the whole body MRI, "may serve as a valuable noninvasive tool for risk stratification in patients with diabetes," especially if accompanying trials on a much lager scale serve to verify their ... Read more

CRT Devices Implanted in HF Patients via …

Based on the results of a prospective observational feasibility study, an electromagnetic tracking device has effectively directed the implantation of cardiac resynchronization therapy (CRT) devices in patients with heart failure (HF). According to the study background, Sergio Richter, MD, and peers used the new sensor-based system (MediGuide, St. Jude Medical) as a substitute of a conventional fluoroscopy-based implantation procedure in order to cut radiation exposure to doctors and patients. Recent data was published, illustrating the average total fluoroscopy time in routine CRT implantation practices was 22 minutes. Richter and peers, who are all part of the department of electrophysiology, Heart Centre, University of Leipzig, Germany, utilized the electromagnetic tracking system to implant CRT devices in 15 patients with HF (average age, 66 years; 53% men) from January to February 2012. Average left ventricular ejection fraction was 27%, and 13 patients were being given a CRT device for the first time. The researchers followed-up with patients for 4 weeks following implantation. The researchers then managed to place an LV lead in all 15 subjects, while avoiding any adverse events. However, 33% experienced slight intra-procedural complications, causing the operator to toggle back to a more conventional fluoroscopy; such was the instance in two cases. Total procedure time amounted to 116 minutes. The total average fluoroscopy time was clocked at 5.2 minutes. The average fluoroscopy time for LV lead implantation was 2.6 minutes, while no fluoroscopy was required for coronary sinus cannulation in 12 of the 15 patients.And after a one month follow-up, no serious adverse events or issues with pacing constraints were reported. Based on information from the study background, the system is comprised of sensors that are fixed in tools which produce electrical currents once implanted within an alternating electromagnetic field and are tracked in real time. A reference sensor is put on the patient’s chest and it gathers information regarding the spatial relationship between the patient and the electromagnetic field. “The field generator is installed within the fluoroscopy detector of an X-ray system. This enables a 3-D image of the placement of the implantation tools to be projected onto pre-acquired X-ray images, and visualization inside a moving organ is possible. In conventional fluoroscopy, only 2-D intracardiac orientation can be achieved,” the researchers wrote. “This new technology has the potential to revolutionize the way we image inside the body while we perform a wide range of diagnostic and therapeutic interventions in the future,” said Richter. However Richter and the rest of the research team conclude that future studies need to be performed in order to verify their ... Read more

Magnetic Resonance Imaging Prior to Ablation for …

According to results of Delayed Enhancement (MRI determinant of successful Catheter Ablation of Atrial Fibrillation (DECAAF) trial),  for patients with atrial fibrillation, a delayed enhancement magnetic resonance imaging (DE-MRI) performed prior to ablative treatment can stage the extent of damaged heart tissue (atrial fibrosis) and help determine whether treatment will be a success or not. "The DECAAF results show that stage of atrial fibrosis prior to ablation is a new, powerful, independent predictor of outcome," said lead investigatorfrom the CARMA Center at the University of Utah in Salt Lake City, USA, Nasir Marrouche, MD. "By performing this imaging before ablative treatment we can triage patients according to likelihood of treatment success, and avoid ablative procedures in those patients for whom it is unlikely to work. If a patient has late stage 3 or stage 4 fibrosis their chance of being cured is only 30-35% which is really low, but if they're in an early stage their chance of cure is 60-80 percent.” The DECAAF trial involved 260 atrial fibrillation (AF) patients with atrial fibrosis who were scheduled for ablation. The patients, taken from 15 centers in the USA, Europe and Australia were an average age of 59 years, with 64.6 percent of them had paroxysmal AF. High resolution Delayed Enhancement MRI (DE?MRI) was performed up to 30 days prior to ablation in all patients to assess the presence and degree of atrial fibrosis, while post- ablation DE-MRI was carried out at 90-days follow-up in 177 of the patients, in an attempt to find out the degree of remaining ablation. For the 90-day follow-up, return of arrhythmia was apparent in 88 of the 260 patients (33.8 percent) based on Holter monitors and electrocardiograms. Multidimensional analysis showed two independent indicators of successful ablation or returning symptoms were stage of atrial fibrosis prior to ablation ... Read more

Cause of Sudden Cardiac Death may be Revealed Through …

Researchers have been able to identify chronic, subacute, acute and peracute MI using post-mortem cardiac MRI on human forensic bodies of patients who suffered sudden cardiac death. The imaging technique, they wrote, may present a promising alternative to clinical autopsy. The researchers performed post-mortem MRIs with a 3-T system on the bodies of 136 patients who most likely died of cardiac causes prior to forensic autopsy.  Post-mortem MRI identified at least one ischemic lesion in 76 of the 136 cases. The causes of death in these cases were ruled to be cardiac-related in the final forensic case ecaluation. In these patients, the researchers discovered 124 myocardial lesions, 25 of which were chronic, 16 subacute, 30 acute and 53 peracute. Verification of chronic, subacute and acute lesions could be made histologically and macroscopically, with 100% agreement between autopsy and post-mortem MRI findings. However, the researchers were incapable to look at peracute lesions macroscopically on autopsy, but were able to verify peracute lesions discovered on post-mortem MRI scans in specified histological evaluations in 62.3% of cases. Peracute lesions could then be connected to a matching coronary finding in 84.9% of cases. The remaining 15.1% did not have a matching coronary finding but presented with severe myocardial hypertrophy or cocaine intoxication. “Post-mortem imaging is a new tool to explore [sudden cardiac death]. As in popular television series, the careful collection and analysis of data from different sources, including clinical information and advanced post-mortem imaging, lead to the identification of the cause of death. From an epidemiological point of view, it will probably reduce the number of cases of unknown origin and may contribute to the establishment of a cost-effective diagnostic protocol,” wrote André Schmidt, MD, PhD, of the Medical School of Ribeirao Preto, University of São Paulo in Brazil, in an ... Read more

Unknown Extracardiac Malignancies Discovered in CT…

Based on a new study published in the American Journal of Roentgenology, cardiac CT identifies grave extracardiac malignancies in one out of every 150 patients, a discovery that could have severe repercussions on who should be allowed to read and interpret heart CT scans; radiologists, cardiologists, or perhaps both. In a large scale analysis that involved 15,000 patients distributed across 19 studies, CT scans revealed a rate of about 0.7% of serious extracardiac malignancies, three-fourths of which were all previously unknown, noted the research team.  However researchers reported that the commonness of all cardiac abnormalities, not only cancers, differed widely across the studies. "Although the prevalence of reported incidental extracardiac finding at cardiac CT was highly variable, a homogeneous prevalence of previously unknown malignancies was reported across the studies," Dr. Nicola Flor and colleagues from Azienda Ospedaliera San Paolo and other clinics in Milan wrote. Extracardiac discoveries at cardiac CT call for specific assessment and coverage, they stated. The authors also mentioned that Cardiac CT, the original diagnostic tool for patients at low and moderate risk of coronary artery disease, is noticeably different from other cardiac imaging systems such as echocardiography, SPECT myocardial perfusion imaging, and traditional angiography in its ability to detect extracardiac cancers in a wide array of organs and areas. "Cardiac CT images generally include portions of the lungs, pleura, chest wall, mediastinum, dorsal spine, and upper abdomen. Considering the increasing availability of advanced CT scanners and the number of cardiac CT studies, incidental extracardiac findings are frequently detected in clinical practice. Of these, significant numbers are previously unknown malignancies,” wrote Flor and the research team. Several studies have observed minor cardiac findings, but the aim of this analysis was to examine the commonness of extracardiac findings in cardiac CT patients in order to develop an estimate of how often they occur. The research team took to digging and pulling relevant information in the PubMed, Embase, and Cochrane databases for studies reporting minor extracardiac findings on CT. After heavy review that involved both manual and computerized searches, 19 studies including 15,877 patients (67% male) were found to meet the study criteria. In all, 15,877 patients (10,194 male and 5,683 female) were included in the analysis. In conjunction with the subjects' clinical status, two studies involved healthy volunteers, 13 were limited to patients with possible coronary artery disease, and two included patients with atrial fibrillation. One study examined patients undergoing calcium scoring, while another looked at the pulmonary veins. Another study assessed coronary artery bypass grafts, and a final study examined a combination of these different patient groups. The authors executed a three-level analysis to determine the prevalence of patients with extracardiac findings, followed by the prevalence of patients with significant cardiac findings, and finally the prevalence of patients with verified cancer. Across all 19 studies, the prevalence rate for detecting an incidental extracardiac abnormality was 44% (95% confidence interval [CI]: 35%-54%) or about one in every 150 patients scanned. However, the data was crippled by a high heterogeneity that challenged efforts to explain it by analyzing the subjects. Some studies had large findings of extracardiac, while others had very few. The prevalence rate for the detection of a major incidental extracardiac finding was 16% (95% CI: 14%-20%). The authors estimated that several determinants, particularly different levels of attention given to detecting incidental findings to begin with, played a key role in the diversity of prevalence rates. The prevalence became more consistent and predictable when detecting incidental cancers rather than just findings, especially for previously unknown cancers. The collected cancer prevalence for 10 studies that included 5,082 patients was 0.7% (95% CI: 0.5%-1.0%), with almost ideal homogeneity, the authors noted. The 29 reported malignancies included 21 (72%) lung cancers, three thyroid cancers, two breast cancers, two liver cancers, and one mediastinal lymphoma. "From an epidemiologic and clinical point of view, our results pointed out that performing cardiac CT implies a nonnegligible probability to diagnose a previously unknown cancer, which can be compared with that observed in recent CT trials for lung cancer screening, ranging from 0.3% to 2.7%, depending on population characteristics such as age, sex, and smoking history," said the authors. One other helpful point is the fact that numerous risk factors for lung cancer echo those for coronary artery disease; thus, "referring physicians, patients, radiologists, cardiologists, and cardiac surgeons should be aware that when cardiac CT is performed, a collateral screening for extracardiac malignancies, mostly lung cancers, is being performed as well," the study team wrote; with some findings warranting instantaneous attention. "For approximately 0.5% to 1% of patients undergoing cardiac CT, an incidental extracardiac finding may be immediately more important than a high calcium score or a coronary artery stenosis," Flor and colleagues wrote. "This prevalence of incidental extracardiac findings implies a relevant issue for the medical profession: Cardiac CT deserves careful analysis and reporting by radiologists who should have both cardiac and thoracic (lung) CT expertise. As an alternative, if cardiologists report on only the 'cardiac' CT study, a second review should be performed by a thoracic radiologist, resulting in a double cost to healthcare systems for reporting cardiac CT ... Read more

Blood Marker may Identify Coronary Danger…

Japanese researchers seem to have discovered a noninvasive method to potentially spot soft coronary lesions that are easily prone to rupture and cause a severe heart attack. Blood levels of the recently released inflammatory biomarker pentraxin 3 (PTX3), which is connected to C-reactive protein, were considerably higher in patients with thin fibrous capped coronary lesions than in those without, noted Seiji Koga, MD, of Nagasaki University Graduate School of Biomedical Sciences in Nagasaki, Japan, and peers. According to the study published online in the JACC: Cardiovascular Interventions; the researchers utilized optical coherence tomography and intravascular ultrasound to assess lesions. From a pool of 75 patients, 47 had stable angina and 28 had acute coronary syndrome. The average age of those with and without thin caps was 66, and 69, respectively. Prior researchers have stipulated that PTX3 might play a fundamental role in the progression of atherosclerotic lesions, but the current study cannot present such a relationship. Baseline MRI scans excluding late gadolinium enhancement seemed to distinguish patients with idiopathic dilated cardiomyopathy who would not need an implanted device, a small study suggested. All 56 patients had increased left ventricular volume and reduced ejection fraction, yet the 30 patients without late gadolinium enhancement (LGE) on MRI remained free of LGE after a follow-up of two years. According to Pier Giorgio Masci, MD, of Fondazione Toscana Gabriele Monasterio in Pisa, Italy, and peers, the LGE interrelated with positive structural and functional results including reductions in left ventricular mass with a simultaneous increase in stroke-volume and ejection fraction. In the study published online in Circulation: Cardiovascular Imaging, patients with LGE at baseline had LGE at follow-up, which corresponded with worse structural and functional results.The overall average age of patients was 55, two-thirds were women, and one-quarter had previously been hospitalized for heart failure. Moreover, a new app called GRACE 2.0 will aid physicians in determining the long-term risk stratification (1 to 3 years after hospital admission) in patients with acute coronary syndrome (ACS). GRACE 2.0, which set to be released, is an improvement over the original GRACE app, which determines the 6-month risk. The original app is available for the web and for the iPhone. GRACE (Global Registry of Acute Coronary Events) is an international observational database of outcomes for patients with ACS. It includes 100 hospitals in 14 countries that register a total of 10,000 patients a year. The GRACE risk score has been authenticated and is highly recommended by ESC Guidelines for acute management of ACS. A pilot study suggested that determining a patient's vascular age from carotid intima-media thickness (CIMT) and adding that to the Framingham risk score (FRS) may be a promising formula for identifying those at risk of an acute heart attack. Ash Kabra, MD, of the Lehigh Valley Health Network in Allentown, Pa., and peers reported that the average  age of the 26 patients who presented with ST-segment elevation myocardial infarction (STEMI) was 52, but the CMIT-calculated vascular age added an average of 26 years to the chronological age. Use of vascular age to categorize risk considerably raised the average FRS from 12.1% to 16.6% and the analogous average 10-year event rate from 10.2% to 17.2%, reported in the journal ... Read more

Strokes Linked to Contaminated Steroid Injections…

According to researchers who conducted and released several small case studies, a need for a "high index of suspicion for possible fungal meningitis" when ischemic stroke takes place in the subsequent circulation and patients have a history of epidural spinal injections is curial. Of these three cases, one patient suffered a stroke a whole month following an epidural injection of tainted methylprednisolone. While the remaining two experienced stroke just after 2 weeks of injection, said senior author and neurologist at Vanderbilt University in Nashville, Daniel O. Claassen. In the previous year, a compounding pharmacy in Massachusetts distributed contaminated methylprednisolone, which resulted in many deaths from fungal meningitis. "We are finding all sorts of new presentations of fungal infections of the central nervous system. This particular fungus is angiotropic, which means it likes blood vessels. We think it is traveling and creating an inflammatory reaction in blood vessels. That's why we are seeing presentations of stroke,” said professor in the division of infectious diseases at the University of Texas Health Science Center at Houston, Luis Ostrosky, MD. Two patients had small-vessel infarcts, while one had a large-vessel infarct. The infarcts were fueled by basilar, superior cerebellar, and posterior cerebral artery branches. The infection can fester over a period of 1 to 4 weeks between the last spinal injection and when a patient seeks medical help. Early MRI scans exhibited signs of a standard ischemic stroke. All three patients had at least one or more potential stroke risk factors.  “Presenting with stroke is not completely atypical for this disease, but the rate is not abnormally high,” said Claassen. Furthermore, in possible cases of infection, a screening MRI may provide early warning of spinal or paraspinal meningitis. For the first case study, a 78-year-old man experienced acute onset of left-sided weakness and speech disorder, yet exhibited no meningeal symptoms at the time. Following the third day, MRI scans showed infarct expansion, and the patient's left-sided weakness increased. He died on the sixth day. An autopsy revealed fungal cerebral vasculitis and Exserohilum species were discovered microscopically. The second case involved a 78-year-old woman who complained of headache, vertigo, and nausea. She had mild ataxia and MRI scans showed ischemic infarcts in the posterior circulation, one indicator of a large-vessel infarct, but stenosis was omitted on CT angiography. She became feverish on the fourth day and neurologists noted mild encephalopathy. MRI revealed a new infarct as her health continued to decline. Because of her history of epidural injections and, at the time, recent reports of fungal meningitis, researchers performed a lumbar puncture and results called for antibiotics. She died 50 days later. An autopsy showed hyphal fungal forms in the arterial wall that researchers assumed signified Exserohilum species based on CDC studies. For case 3, a 70-year-old woman, exhibited headaches, fever, and was off-balance. She had been administered an epidural spinal injection 1 month prior. MRI revealed small-vessel ischemic strokes, but MR angiography did not point to any major stenoses. Again, concerned for meningitis led to a lumbar puncture and according to results, antibiotics were started. She was released 37 days later. "These cases highlight a diagnostic dilemma for neurologists. Patients with fungal meningitis who present with ischemic strokes may be afebrile, lack signs of meningeal irritation, and have traditional stroke risk factors," Claassen and fellow researchers said. "An awareness of the presentation and vascular sequelae of fungal meningitis in immunocompetent patients should lead to earlier treatment and improved outcomes prior to a definitive diagnosis," they ... Read more

Chest Radiation Cancer Patients Should Undergo CV …

According to the European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology (ESC) and the American Society of Echocardiography (ASE) cancer patients who are given chest radiation should be screened for heart disease every 5 to 10 years or so. Published in European Heart Journal - Cardiovascular Imaging.1, their recommendations are presented in the very first consensus statement on screening for radiation-induced heart disease (RIHD). "The prevalence of radiation-induced heart disease is increasing because the rate of cancer survival has improved. It's a long term risk, and RIHD manifests 5-20 years after the radiation dose,” said chair of the expert task force and president of the EACVI, Professor Patrizio Lancellotti. "Survivors of Hodgkin's lymphoma and breast cancer received high doses of radiation on their chest under the old treatment regimes. Over time these patients can develop RIHD in the heart valves, myocardium, vessels including the aorta, the pericardium, and the coronary arteries. Their risk of death from coronary artery disease, myocardial ischemia and myocardial infarction is increased,” added Lancellotti. He went on to say, "Radiotherapy is now given in lower doses but patients are still at increased risk of RIHD, particularly when the heart is in the radiation field. This applies to patients treated for lymphoma, breast cancer and oesophageal cancer. Patients who receive radiotherapy for neck cancer are also at risk because lesions can develop on the carotid artery and increase the risk of stroke." RIHD is expected to take place in 10-30% of patients who are given chest radiotherapy within 5-10 years following treatment. Cardiac structural and functional changes after radiation can be identified early using echocardiography, cardiac computed tomography (CT), cardiac magnetic resonance (CMR) and nuclear cardiology. However, screening for RIHD has never been common practice. In the report, experts detail that: -    Before initiating any chest radiotherapy, patients should have screening for RIHD risk factors, a clinical examination, and a baseline echocardiographic evaluation. -    Patients who receive chest radiation for cancers including breast cancer or lymphoma should receive cardiac screening 5 years post-treatment if they have any cardiac abnormality or are at high risk and 10 years post-treatment if not. -    Cardiovascular screening should be repeated every 5-10 years depending on the presence of cardiac abnormalities and the level of risk. -    All patients who had chest radiation for cancer in the past should receive a cardiac examination starting with echocardiography. Patients are put at a greater risk of having RIHD if they have radiation for left-sided breast cancer, have a high dose of radiation (often used in young people), the irradiated area is not shielded, have a high dose of anthracyclines (chemotherapy), or have cardiovascular risk factors including smoking, obesity and inactivity. "We wrote the expert consensus to raise the alarm that the risks of radiation-induced heart disease should not be ignored. Cardiovascular screening is needed before and after radiation therapy to detect RIHD early, follow up patients at appropriate intervals, and define the optimal timing for any kind of intervention,” said Lancellotti. Lacellotti also noted that while echocardiography is the first line of imaging assessment, other examinations including stress imaging, CT, and CMR are required to appropriately evaluate the presence of myocardial fibrosis using CMR and more precisely calculate cardiac calcification using CT. "A registry of RIHD is needed in Europe to determine the true prevalence of the disease and collect outcome data. This together with screening should reduce the risk of patients developing RIHD and enable us to treat it early when it does occur,” he ... Read more

Score System Determines PCI Readmission…

According to a study published online in Circulation: Cardiovascular Quality and Outcomes, a new 30-day readmission risk predication model for patients undergoing percutaneous coronary intervention (PCI) demonstrated that it indeed possible to predict risk using known data prior to PCI. After several adjustments, the 10 pre-PCI variables that predicted 30-day readmission were older age (average age 68), female, insurance type (Medicare, state, or unknown), GFR category (less than 30 and 30-60 mL/min per 1.73m2), current or history of heart failure, chronic lung disease, peripheral vascular disease, cardiogenic shock at presentation, admit source (acute and non-acute care facility or emergency department), and previous coronary artery bypass graft surgery. Moreover, important determinants post-discharge that determined 30-day readmission were beta-blocker prescribed at discharge, post-PCI vascular or bleeding complications, discharge location, race, diabetes status and modality of treatment, any drug-eluting stent during the index procedure, and extended length of stay. Robert W. Yeh, MD, MSc, of Massachusetts General Hospital in Boston, and peers say a risk score calculator using pre-PCI variables would soon be accessible online. Imaging the cardiac sympathetic function with a radiotracer helps cardiologists to determine the long-term probability of survival in heart failure patients, free of BNP and ejection fraction, a patient-level analysis of six individual studies, grouped together confirmed. The gathered analysis of scintigraphic imaging using iodine-labeled metaiodobenzylguanidine (MIBG), with follow-up of more than 10 years, revealed that patients with a heart-to-mediastinum ratio (HMR) greater than 1.95 had less than a 2% annual death rate, while those with an HMR less than 1.25 had an annual death rate greater than 7%, according to Tomoaki Nakata, MD, of the Sapporo Medical University School of Medicine in Sapporo, Japan, and colleagues. Individual patient risk for HMR levels were low (HMR greater than 2.10), intermediate (HMR 1.40-2.10), and high (HMR less than 1.40). "Although the MIBG imaging technique has been readily available in Japan for 2 decades, the new insights provided by this pooled analysis should expand understanding of the importance of the sympathetic nerve findings," researchers noted in their study published in JACC: Cardiovascular Imaging. By recognizing patients at high risk of death, physicians can better select those patients who would benefit the most from an implantable cardioverter defibrillator, the researchers added. According to Bruce L. Wilkoff, MD, of the Cleveland Clinic, and peers the safety and overall efficiency of transvenous extraction of recalled leads from implantable cardioverter defibrillators (ICDs) is comparable to non-recalled leads. Furthermore, a study published online in Heart Rhythm drew a comparison between 430 patients with recalled leads (Riata and Sprint Fidelis) and 649 with non-recalled leads and yielded no significant differences in minor or major complication issues. "The FDA and the Heart Rhythm Society do not currently recommend prophylactic extraction of recalled Riata or Fidelis ICD leads. Our study contributes to the existing body of knowledge by showing that in our high-volume center, extraction of recalled Riata and Fidelis ICD leads was performed with comparable safety and efficacy to non-recalled ICD leads,” said the ... Read more

TBI Patients More Likely to Suffer from Ischemic Stroke…

According to a study published online in the journal, Neurology, it was discovered that 30 percent of patients who endured some form of traumatic brain injury (TBI) has been linked with a succeeding ischemic stroke; a discovery that could impel stroke prevention efforts in young trauma patients. “The magnitude of this association was substantial (HR [hazard ratio] 1.31) and was similar to the association between the leading stroke risk factor, hypertension (HR 1.34), and ischemic stroke,” said professor of the University of Michigan, Ann Arbor, James F. Burke, MD, MS, and his team. Ischemic stroke is the number one cause of acute disability in adults and around 20 percent of strokes take place in those patients younger than 65 years, mentioned the researchers. However, no exact stroke systems have been recognized in the young and working age populations, as researchers wished to assess the correlation between TBI and stroke. With using the data collected by the state of California, between the years 2005 to 2009, the researchers determined a retrospective auxiliary of more than 1.1 million trauma patients, 37 percent of which had TBI. The remaining patients did have trauma, however it was not brain-related. Over a median of 28 months of following-up after the injury, 1.1 percent of patients with TBI suffered a stroke, as opposed to 0.9 percent of those who did not suffer a stroke, found Burke and his research team. After making the necessary adjustments for a number of potential confusing variables, patients with TBI related admittances were 30 percent more likely than those non-TBI patients to incur a succeeding hospitalization due to suffering from a stroke. This was significant and complementary to other vascular risk determinants, the researchers determined that given the high percentage of TBI in most trauma patients registered in the study, TBI was the leading cause for more ischemic stroke than hypertension in that study group. Yet in spite of what the researchers identified as “robust” association, the absolute ischemic stroke risk difference between the TBI and non-TBI group remained minimal. “Nonetheless, if further research definitively established TBI as a novel stroke risk factor, this would stimulate research to understand stroke pathophysiology after TBI and inform stroke prevention efforts in this young population with few vascular risk factors,” noted Burke and his ... Read more

Application of CAD Used to Automatically Register …

Based on a study recently published in the June issue of Academic Radiology, the assortment and prioritization of patients with severe chest pains may soon become a simpler process, as an introduction of a computer-aided simple triage (CAST) system for mechanical stenosis detection can correctly classify patients with major stenosis. “Given the significance of coronary artery disease as the most important socioeconomic health care problem in the Western world, the application of CAD [computer aided detection] algorithms and diagnosis techniques to this disease is surprisingly rare,” said professor at University Medical Center Mannheim, Germany, Mathias Meyer. “This study demonstrates that the cCTA [coronary CT angiography] CAST system evaluated in this study is a reliable tool to rule out significant stenotic coronary artery stenosis on a per-patient as well as on a per-vessel level and especially improves the diagnostic accuracy of an inexperienced reader in a consecutive cohort of patients with acute chest pain and an intermediate risk for ACS [acute coronary syndrome],” he added. Evaluating patients who are admitted to an emergency room with undetermined chest pain is a difficult task, albeit cCTA can consistently rule out considerable coronary artery stenosis in patients with a low- to intermediate-risk profile for ACS, noted the study. “However, a major limitation of cCTA for evaluation of chest pain patients in the ED is the lack of available experienced readers, especially during nighttime and weekend hours.Therefore, a CAD system with consistent performance for coronary artery stenosis detection appears desirable.” Meyer and peers looked to evaluate a CAST system, which is a branch of CAD used to carry out preliminary triage, unlike standard CAD systems which operate solely as a second reader. The study originally enrolled 93 patients with severe chest pain and intermediate risk of ACS, of which 74 had satisfactory cCTA image quality for automatic analysis by the CAST system. The CAST system identified stenosis of 50 percent or more in 45 patients, as opposed to interpretations made by physicians, which recognized 37 patients with major stenosis. For every patient, the CAST system had a sensitivity and specificity of 100 and 78 percent, for every vessel, sensitivity and specificity was 79 and 89 percent. The researchers also observed the influence of CAST guidance on an inexperienced reader and discovered the system boosted overall improvement. Sensitivity and positive predictive values for inexperienced readers in identifying major stenosis saw an increase from 69 and 41 percent respectively, without the use of CAST, to 91 and 74 percent, respectively, with CAST. Meyer and peers also cited that motion artifacts lessened image quality in some instances, caused vessels to be inaccurately recognized and the presence of stenosis to be overcalled. Yet they also noticed sensitivity and negative predictive value remained constant. “In addition, such CAST systems can be used to perform a reading order prioritization, example: by giving higher priority to cases deemed positive by the system or by assigning more experienced readers to positive or low quality cases and less experienced to simple negative ... Read more

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