bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidental CT findings from myocardial perfusion PET/CTs
Authors: Berenji G , Puente C A , Niknam K H , Packard R 
Published: June 2024

Abstract

Introduction
New state-of-art hybrid imaging systems provide high quality CT images along with myocardial perfusion imaging (MPI), which introduces new opportunities and challenges for interpreting and referring physicians. American and European societies recommend reporting these CT scans including non MPI related incidental findings. PET MPI studies provide CT that allows examination of the chest and upper abdomen in addition to the heart and coronary vessels. Previous studies demonstrated these incidental findings may have an important impact on detection of malignancies or other abnormalities depending on the studied population. The objective of this study was to describe the prevalence of CT incidental findings during MPI PET/CT. We hypothesized that the veteran population may have a high prevalence of incidental CT findings based on their risk factor profile.

Methods
This IRB-approved single-center retrospective study included 2756 patients, who underwent 82-rubidium-chloride PET-CT MPI between December 2018 and July 2022. Each patient received a low dose CT of the chest and upper abdomen for attenuation correction and anatomic localization. At our institution, complete CT reports are generated by board certified nuclear medicine physicians or cardiologists with special competency in CT interpretation. Data collected by reviewing the MPI reports resided in the PACS system. Incidental CT findings were identified, and percentages of each finding were calculated.

Results
In addition to abnormal PET MPI findings including ischemia and/or scar, the thoracic CT demonstrated incidental findings in aorta (14%), pulmonary artery (20%), coronary arteries (94%), lung (50%), lymph nodes (3%), and breast (12%). The upper abdominal CT findings included the liver (14%), gallbladder (10%), spleen (3%), kidneys (13%), stomach (10%), and ascites (1%). Some of these findings were deemed serious which required follow up imaging.

Conclusion
Our study again confirms the importance of reviewing and reporting CT component of MPI studies as recommended by American and European societies. These CT images frequently, demonstrate incidental thoracic and upper abdominal findings, some of which require further workup. However, these findings can be burdensome for the referring physician and may cause patient anxiety. Hence, adequate training and experience or a multispecialty approach may be necessary to accurately interpret and provide differential diagnosis and recommendation to minimize the healthcare burden and anxiety for patients while maximizing the clinical benefits.
Baseline left ventricular ejection fraction assessed by cardiac computed tomography in patients undergoing transcatheter aortic valve replacement
Authors: Lopes V , Moreira N , Fernandes R , Cunha G , Ramalho A , Teixeira R , Goncalves L 
Published: June 2024

Abstract

Introduction
Left ventricular systolic dysfunction has been associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). Patients undergoing TAVR routinely undergo cardiac computed tomography (CCT) to plan the procedure. Left ventricular ejection fraction (LVEF) can be assessed by CCT, but its association with prognosis in patients undergoing TAVR in unclear.

Purpose
To investigate the association between LVEF assessed by CCT and clinical outcomes after TAVR.

Methods
We retrospectively assessed baseline LVEF using preprocedural CCT in patients undergoing TAVR. Two groups were identified: (1) patients with an LVEF of &lt;50%, and (2) patients an LVEF of ≥50%. Baseline clinical characteristics, laboratory data, and clinical outcomes were analyzed. The primary endpoint was major adverse cardiac events (MACE) at 1 year, defined as a composite of all-cause mortality, heart failure hospitalization, and stroke.

Results
A total of 157 consecutive TAVR patients were included in the analysis: median age was 82 (IQR 8) years, and 55% (n=86) of patients were male. Mean LVEF assessed by CCT was 56.3 ±15.1%, and 29% (n=45) of patients had an LVEF &lt;50%.
Groups were comparable regarding age and sex. Compared with patients with normal LVEF, patients with low LVEF were more likely to have a history of myocardial infarction (4.5% vs. 17.8%, p=0.01). There were no significant differences regarding other baseline comorbidities and laboratory analysis between groups.
Regarding CCT findings, patients with left ventricular dysfunction had a larger LV [indexed LV end-diastolic volume 82 (IQR 26) vs. 108 (IQR 39) ml/m2, p&lt;0.001], and a lower right ventricular ejection fraction [43 (IQR 9) vs. 35 (IQR 13) %, p &lt;0.001].
Regarding prognosis, after 1 year post-TAVR, 13.5% (n=24) of patients experienced the primary endpoint. Rates of MACE did not differ between groups (12.6% vs 15.6%, p=0.63; HR 1.27, 95% CI 0.51-3.15, p=0.61), although patients with an LVEF &lt;50% were numerically at higher risk. When LVEF was treated as continuous variable, it was also not found to be associated with increased 1-year risk of MACE (HR 0.98, 95% CI 0.96–1.01; p=0.16) or all-cause mortality (HR, 0.97; 95% CI 0.93–1.00; p=0.07). Main results are presented in Table 1. Kaplan-Meier survival curves can be seen in Figure 1.

Conclusion
The assessment of LVEF using preprocedural CCT in patients undergoing TAVR is possible. Baseline LVEF assessed by CCT was not found to be an independent predictor of 1-year MACE after TAVR.Table 1 Figure 1
Left ventricular ejection fraction by computed tomography in severe aortic stenosis patients - real world experience
Authors: Costa G , Silva A L , Ramalho R , Vieira M J , Goncalves L , Teixeira R 
Published: June 2024

Abstract

Introduction
The left ventricular ejection fraction (LVEF) is pivotal for predicting cardiac outcomes and treatment decisions, with multiple imaging methods available for its assessment. While cardiac computed tomography (CCT) serves as a standard test to evaluate the aortic valve structure prior to transcatheter aortic valve implantation (TAVI), it typically focuses on assessing the aortic valve rather than routinely providing quantitative information about LVEF despite its capability to offer insights into other cardiac structures.

Purpose
The aim of this study is to assess the correlation and agreement between LVEF measured by two-dimensional transthoracic echocardiography (TTE) and CCT in severe aortic stenosis patients.

Methods
Single-center, retrospective study. Patients undergoing CCT preceding TAVI for severe aortic stenosis from June until December 2023 were selected. Patients without measurements for both TTE and CCT LVEF were excluded from the analysis. The paired-sample T-test and Pearson's coefficient of correlation (r) were calculated, and the Bland-Altman plot was inspected to assess the between-agreement measurements of the two modalities, using SPSS 28.0.1.1 software.

Results
Of the 113 patients with severe aortic stenosis identified, only 42 (37.2%) had measurements of both TTE and CCT LVEF and were enrolled in the analysis. The mean age of the population was 82.3 (±6.8) years, 64.3% female. Cardiovascular risk factors were significantly prevalent: 90.0% had arterial hypertension, 75.0% had dyslipidemia, and 47.5% had diabetes. The prevalence of coronary artery disease was considerable (28.2%). Based on the LVEF-TTE assessment, 21.4% of patients had LVEF inferior to 50%.
Despite a statistically significant difference between TTE and CCT LVEF means (55.5±10.6% vs. 61.9±15.4%, p&lt;0.001), a positive moderate correlation was observed between the measurements (r=0.606; p&lt;0.001). In the subgroup analysis, the correlation was stronger in patients with LVEF lower than 50% (r=0.759, p=0.018) when compared with the higher LVEF group (r=0.427; p=0.013).
Analyzing the Bland-Altman plot of LVEF from the comparison between the two imaging modalities, CCT showed an overall tendency to overestimate LVEF (mean difference=-6.43±10.56%), particularly with LVEF increasing.

Conclusion
Despite a moderate correlation, CCT gives considerably different LVEF measurements than TTE in severe aortic stenosis patients undergoing CCT prior to TAVI. CCT showed a tendency to systematically overestimate LVEF, highlighting the importance of careful interpretation when comparing these imaging findings.
Assessing the efficacy and safety of propranolol for cardiac computed tomography in severe aortic stenosis - defying the norm
Authors: Costa G , Silva A L , Cunha G , Guimaraes J , Fernandes D , Monteiro E , Ramalho A R , Vieira M J , Goncalves L , Teixeira R 
Published: June 2024

Abstract

Introduction
Cardiac computed tomography angiography (CCTA) is a crucialexamination in the planning of percutaneous aortic valve implantation (TAVI) for patients with severe aortic stenosis. However, proper heart rate control is essential for obtaining high-quality images through cardiac CCTA, reducing the occurrence of motion artifacts. Intravenous beta-Blockers (BB) are usually used to induce bradycardia during CCTA but are contra-indicated in patients with aortic stenosis. Oral propranolol is a non-selective BB that pharmacodynamics may be favorable for this subset of patients.

Methods
This is a single-center prospective observational study that included patients with severe aortic stenosis admitted for CCTA for TAVI planning. Patients with pacemakers were excluded. Patients with HR 55-64 bpm and systolic blood pressure (BP) &gt; 105 mmHg were administered 5 mg oral propranolol and patients with HR &gt;65 bpm and systolic BP were administered 10 mg. HR, symptomatic bradycardia and hypotension were assessed.

Results
We included 92 patients between July and November 2023. 48 patients were male (52%). Mean age was 76 ± 6,3 years. Atrial fibrillation was presented 32 patients (34,7%). In patients that oral propranolol was administered a mean HR difference was –7,86 ± 10,64 bpm versus 1,75 ± 7,41 bpm in patients without BB prior to CCTA. Mann-Whitney test yield a statistically significant result (P &lt; 0.01) between the 2 groups. No symptomatic bradycardia or hypotension was reported,and all patients were safely discharged.

Conclusion
Our study suggests that oral propranol proved a safe and usefulagent for lowering HR in patients with severe aortic stenosis undergoing CCTA pre-TAVI.
Calcium hides the clue: unraveling the diagnostic value of early coronary calcium scoring in cardiac arrest survivors
Authors: Martins A , Rigueira J , Alves Da Silva P , Garcia A B , Oliveira C , Valente Silva B , Placido R , Silva D , Pinto F J , Almeida A G 
Published: June 2024

Abstract

Aim
To find if CAC in non-gated CT scans performed in OHCA survivors could be a good predictor of coronary artery disease and help select those who effectively require CA. Assess the rate of CAC reporting.

Methods
Single-center, retrospective study of OHCA survivors without STEMI. We selected those who performed a non-gated chest CT as a part of an etiological study and underwent CAG due to clinical, ECG or echo suspicion of ACS. An investigator blinded to the CAG report, evaluated CAC quantitatively (with Agatston score) and qualitatively (absent, mild, moderate or severe).

Results
45 pts were included, 71% male, mean age of 5710 years old. 88,9% of the OHCA were witnessed, with mean no-flow time of 4±7min and low-flow time of 18,3±13,6min. Most pts presented with ventricular fibrillation or non-specified shockable rhythm (22,4% each). CT scans were performed with a mean of 3,7h after first medical contact. CAC was identified in 57,8% pts and classified as mild, moderate and severe in 11,1%, 24,4% and 22,2%, respectively. Mean Agatston score: 387 322UA. 16pts (33,3%) had significant coronary lesions, of which 80% had angioplasty and 2,2% CABG.
Quantitative CAC assessment accurately predicted significant lesions (AUC=0,873; 95%CI 0,773-0,974, p&lt;0,001). In fact, of the 19 pts without calcification, none showed significant lesions on CAG. Moderate or severe CAC also predicted significant lesions (OR=13,4,95%CI 1,755- 103,68, p=0,012). There was also a good and significant correlation between the vessel with moderate calcification in CT-scan (Agatston score &gt;100] ) and the vessel identified as culprit in CAG (kappa=0,615, p&lt;0,001). The CAC was reported in only 7,7% CT exams, all with severe calcification.

Conclusion
Assessment of CAC in chest CT scans proved to be feasible and had a strong correlation with the presence, severity and location of CAD. Its routine use upfront showed to be an important complement to CT scans report to guide patient care – avoiding time consuming invasive procedure and focusing on neuro-protection.
Simplified, non invasive CCTA based identification of high risk coronary artery disease - long term prognostic implications
Authors: Giannopoulos A , Rossi A R , Steffek Z S , Jurisic S J , Heiniger P S H , Gajic M G , Albertini T A , Benz D C B , Buechel R R B , Kaufmann P A K , Pazhenkottil A P P 
Published: June 2024

Abstract

Background/Introduction
The CT-BCIS-Jeopardy score is a simple angiographic scoring system, enabling quantification of the extent of jeopardized myocardium related to clinically significant coronary artery disease (CAD), using coronary CT angiography (CCTA). Grading only lesions with ≥70% diameter stenosis and ranging from zero (non-significant CAD) to twelve (very extensive CAD), it allows accurate and fast identification of high-risk CAD. We aimed to assess the long-term prognostic value of the CT-BCIS-Jeopardy score.

Methods
Retrospectively, 337 patients with known or suspected CAD referred for CCTA between 2005 and December 2008 were included. The CT-BCIS-Jeopardy score was estimated for all patients using a purpose-developed online calculator, with a score of ≥6 indicating high-risk CAD. Endpoints were all-cause death or myocardial infarction ("hard events") and a composite of major adverse cardiovascular events (MACE). The Kaplan-Meier method was used to identify survival free of MACE, and Cox proportional hazard regression analysis was used to determine independent predictors for MACE.

Results
Mean patients’ age was 61.7±11 years and 216 (64%) were male. High-risk CAD was detected in 88 (26.1%) patients. During a median follow-up of 6.8 (IQR: 5.7-8.5) years, 47 (14%) patients had a hard event and 97 (29%) patients experienced any MACE. Compared to non-high-risk CAD, patients with high-risk CAD had 9.6-fold higher event rate for hard events [9 (19%) vs. 38 (81%); p&lt;0.001] and 22-fold higher annual event rate for any MACE [19 (5.6%) vs. 78 (23%); p&lt;0.001]. When adjusted for age, sex, BMI, and traditional CAD risk factors, a CT-BCIS-Jeopardy score of ≥6 was an independent strong predictor of both, all MACE and hard events.

Conclusions
The CT-BCIS-Jeopardy score is an excellent non-invasive long-term predictor of adverse cardiac events. High-risk CAD identified using the score is associated with significantly higher annual cardiac event rate.Figure 1 Figure 2
Incremental value of a novel AI-based CCTA derived ischemia algorithm over standard CCTA interpretation for predicting myocardial ischemia in suspected coronary artery disease
Authors: Nabeta T , Bar S , Maanniitty T , Min J K , Earls J P , Bax J J , Saraste A , Knuuti J 
Published: June 2024

Abstract

Background
Coronary computed tomography angiography (CCTA) is a widely used non-invasive test to diagnose coronary artery stenosis in patients with suspected coronary artery disease (CAD); however, it does not provide information of the functional ischemia. A novel artificial intelligence -guided quantitative CT ischemia algorithm (AI-QCTischemia) has been established, which comprises a machine-learned method using features of atherosclerosis and vascular morphology from CCTA images to identify the likelihood of myocardial ischemia.

Purpose
The aim of this study is to investigate the diagnostic performance of AI-QCTischemia over standard CCTA interpretation in detecting myocardial ischemia using positron emission tomography (PET) perfusion imaging as a reference standard.

Methods
Patients with suspected CAD referred for CCTA at our University Hospital from February 2007 to December 2016 were analysed. The AI-QCTischemia algorithm was applied by analysts blinded for patient characteristics and clinical outcomes using the CCTA images to detect probability of myocardial ischemia per patient level. In diagnostic reading significant stenosis was defined as 50% on CCTA. The reference standard was ischemia detected by stress 15O-H2O PET.

Results
A total of 1746 patients (mean age 62 ± 10 years, 44% male) were included. Myocardial ischemia by PET was detected in 325 (19%) patients while the other patients had either normal PET or had non-obstructive CAD by CCTA. AI-QCTischemia was found positive in 430 (25%) patients. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the AI-QCTischemia algorithm for the assessment of myocardial ischemia were 87%, 81%, 88%, 61%, and 95%, respectively. Compared with the clinical visual reading of CCTA, AI-QCTischemia demonstrated higher specificity and positive predictive value but somewhat lower sensitivity and negative predictive value. The accuracy of AI-QCTischemia was 87% while it was 86% with visual reading of CCTA. (Figure 1) Compared with diagnostic reading of CCTA (area under the receiver operating characteristic curve [AUC], 0.868), the model including clinical reading and AI-QCTischemia algorithm demonstrated superior discrimination of myocardial ischemia (AUC 0.899, p-value &lt;0.001). (Figure 2)

Conclusions
A novel AI-based ischemia algorithm derived from CCTA has a high diagnostic accuracy for predicting myocardial ischemia defined by PET perfusion imaging in symptomatic patients with suspected CAD. Moreover, combination of novel AI-based ischemia algorithm and clinical reading of CCTA demonstrated that incremental diagnostic accuracy for predicting diagnostic accuracy.Diagnostic accuracy of CCTA and AI-QCT AUC for myocardial ischemia on PET
Cardiovascular risk assessment and atherosclerosis phenotype by coronary computed tomography angiography in a cohort of Italian patients with type 1 diabetes mellitus
Authors: Mushtaq S , Genovese S , Licastro M , Rondinelli M , Gallotta A , Bonomi A , Baggiano A , Fazzari F , Tassetti L , Volpe A , Fusini L , Maragna R , Junod D , Andreini D , Pontone G 
Published: June 2024

Abstract

Objective
Mortality rates are 2- to 4-fold higher in people with type 1 diabetes mellitus (T1DM) than in the general population. Cardiovascular disease (CVD) is the main cause of such excess mortality, with CVD events occurring over a decade earlier than expected. However, while epidemiological studies on CVD and type 2 diabetes mellitus are numerous, less information is available on the prevalence of CVD in patients with T1DM. The primary aim of the study was to evaluate the prevalence of CAD at coronary CT angiography (CCTA) in consecutive T1DM patients referred to our diabetic center and to assess the characteristics of coronary plaques in this population.

Materials and Methods
We prospectively enrolled 109 consecutive T1DM patients referred to our diabetic unit center in CARDT1 study.
Patients underwent a non-contrast CT for calculation of Calcium Score and a CCTA.
Patients were stratified into three risk groups according to the STENO T1 RISK ENGINE and the ESC score. After the finding of CCTA patients were also divided into three groups: normal (no coronary plaques), non-obstructive CAD (lesions ,50%), and obstructive CAD (lesions &gt;50%). The number of segments with any obstructive plaque also was recorded. Each coronary segment was evaluated for the presence of calcified and mixed plaques.

Results
The analytic study population consisted of 88 patients. Fourty-seven were male (53%) and the mean age was 46.42±13.09 years old with a mean duration of diabetes of 24 years.
According to the Steno Type 1 Risk Engine, the mean estimated risk of CVD events over 5 years was 5.1% and 10% over 10 years. Thirty-five patients (48%) and 15 (20%) were classified as low and high Steno Risk, respectively. Moreover 45 (51%) patients have completely normal coronary arteries, 32 (36%) non obstructive CAD and 11 (12%) obstructive CAD.
In patients with obstructive CAD the duration of diabetes was significantly higher than in those with no CAD and not obstructive CAD (40 years vs 17 years and 27 years, respectively, p&lt;0.0001).
Eighty-three% of low risk Steno Score T1DM have normal coronary arteries while 21% of high risk Steno score patients had obstructive CAD and 14% of high Steno risk have no plaque at CTCA. The number of coronary segments diseased was 1.5 (median) in non-obstructive CAD patients and 4 in obstructive CAD patients (p&lt;0.0001).
Among 118 coronary segments diseased, in 51 segments there was a calcified disease and in 65 there was a non prevalent calcified atherosclerotic disease

Conclusions
CCTA is able to restratify the risk of CAD in T1DM according to the presence or absence of CAD.
In contrast with T2 diabetic patients who have a prevalent calcified and diffuse disease, T1DM patients have a more focal and fibrolipidic pattern of CAD.
Incremental prognostic value of artificial intelligence-based automated plaque characterisation on top of ischemia evaluation by CCTA and CCTA/PET
Authors: Bar S , Maaniitty T , Kiatkittikul P , Nabeta T , Bax J J , Min J K , Earls J P , Saraste A , Knuuti J 
Published: June 2024

Abstract

Background
Artificial intelligence (AI)-based quantitative computed tomography (AI-QCT) is a novel tool for automated plaque characterisation and quantitation from coronary computed tomography angiography (CCTA). The prognostic value of various AI-QCT plaque types on top of the presence of ischemic coronary artery disease (CAD) is unknown to date.

Purpose
We aimed to investigate the added prognostic value of the AI-QCT plaque characteristics percent atheroma volume (PAV) %, non-calcified plaque burden (NCPB) %, and calcified plaque burden (CPB) % on top of: 1) A novel AI-based CCTA-derived ischemia algorithm (AI-QCTischemia) which predicts the presence of invasive FFR ≤0.80 using 38 morphological features from CCTA; and 2) ischemic CAD based on hybrid CCTA/15O-H2O positron emission tomography (PET) for the composite of all-cause death, myocardial infarction (MI), or unstable angina pectoris (uAP).

Methods
This was a cohort of 1772 symptomatic patients having undergone hybrid CCTA/15O-H2O PET perfusion imaging to assess the presence of ischemic CAD. Multivariable Cox regressions adjusted for clinical confounders (age, sex, hypertension, diabetes, smoking, typical angina) were performed and compared with the C-index. AI-QCTischemia models were: 1) AI-QCTischemia, 2) AI-QCTischemia+PAV, 3) AI-QCTischemia+NCPB, 4) AI-QCTischemia+CPB. Hybrid CCTA/PET models were: 5) hybrid CCTA/PET, 6) hybrid CCTA/PET+PAV, 7) hybrid CCTA/PET+NCPB, and 8) hybrid CCTA/PET+CPB.

Results
Throughout a median follow-up of 7 years, 177/1772 (10%) patients experienced the composite endpoint. The C-indexes (p-value vs. model 1) of the AI-QCTischemia models were 1) 0.729, 2) 0.748 (p=0.008), 3) 0.743 (p=0.012), and 4) 0.739 (p=0.067). The C-indexes (p-value vs. model 5) of the hybrid CCTA/PET models were: 5) 0.733, 6) 0.751 (p=0.014), 7) 0.746 (p=0.018), 8) 0.745 (p=0.058). AI-QCTischemia and hybrid CCTA/PET imaging performed similarly by means of C-statistics.

Conclusions
PAV and NCPB, but not CPB by AI-QCT plaque analysis improved the prediction of 7-year death, MI, or uAP when added on top of the presence of ischemic CAD, determined either by AI-QCTischemia or hybrid CCTA/PET imaging. Overall, the risk stratification based on AI-QCTischemia performed similarly as hybrid CCTA/PET imaging.C-indexes for death, MI, or uAP