Risultati per: L'imaging nella urolitiasi

Circulation, Volume 148, Issue Suppl_1, Page A16767-A16767, November 6, 2023. Introduction:Cardiac magnetic resonance imaging (CMR) is an important imaging modality for diagnosing cardiovascular diseases and optimizing therapeutic management. We assessed CMR utilization and potential sex disparities for myocarditis, Takotsubo cardiomyopathy (CM), heart failure, and amyloidosis.Methods:Using the TriNetX database, we conducted a comprehensive analysis, querying adults with diagnoses of these four diseases. CMR risk within 1 year of ICD-10 diagnosis was assessed. Trends in CMR incidence proportion and prevalence between 2015 and 2022 were examined. Odds ratios were used to assess the presence of both sex disparities and temporal differences in CMR utilization for myocarditis in the COVID-19 era.Results:Overall increasing prevalence and incidence proportion of CMR for these four diagnoses are presented in Figure 1. CMR utilization for patients with myocarditis (10.4%), remained consistent between 2019 and 2020. However, the odds of CMR slightly increased in 2021 and then declined in 2022. CMR utilization for Takotsubo, heart failure, and amyloidosis diagnoses was lower, 2.4%, 1.3%, and 4.4%, respectively. Odds ratios revealed higher likelihood of CMR ordered for males than females diagnosed with Takotsubo CM [OR 1.352* (1.143, 1.599)], heart failure [ OR 1.248* (1.221,1.277)], and amyloidosis [OR 1.375* (1.261,1.499)].Conclusions:Despite CMR’s diagnostic and prognostic utility in patients with suspected myocarditis, heart failure, Takotsubo CM, and amyloidosis, CMR utilization is rising but low, with significant sex disparities in referral patterns. Further studies are needed to determine how increased CMR utilization impacts cardiovascular disease diagnosis, patient outcomes, and sex disparities.

Circulation, Volume 148, Issue Suppl_1, Page A16668-A16668, November 6, 2023. Rational:Atrial remodelling (AR) is the persistent change in atrial structure and/or function and contributes to the initiation, maintenance and progression of AF. Left atrial (LA) size, geometry, fibrosis, wall thickness (LAWT) and ejection fraction (LAEF) have all been shown to vary with pathological AR. The association of these global remodelling markers with each other for differentiating structural phenotypes in AF is not well investigated.Method:Patients referred for first-time AF ablation and controls without AF were prospectively recruited to undergo cardiac CT and MRI with 3D atrial LGE sequences. LAWT based on the eikonal equation, atrial myocardial mass, LA volume and sphericity were calculated from CT. Biplane LA EF and LA fibrosis burden (IIR method) were derived from atrial MRI. Results were compared between patients with AF and controls. Statistical significance was set at α 0.05.Results:42 AF patients (64.3% male, age 64.6+/- 10.2 , CHA2DS2-VASc 2.48+/- 1.5, 69.0% paroxysmal AF, 31% persistent AF, LVEF 57.9+/-10.5%) and 37 controls (64.9% male, age 56.6+/-7.2, CHA2DS2-VASc 1.54 +/-1, LVEF 60.4 +/- 4.9%) were recruited. Patients with AF had a significantly higher LAWT, mass, fibrosis burden, left atrial size and lower LAEF compared to controls. There was no significant correlation between % fibrosis with LAWT (p 0.573), mass (p 0.775), volume (p 0.407) or sphericity (p 0.855). LAWT had a weak positive correlation with LA volume (p=0.041), but not with sphericity (p 0.86). LAEF had a weak negative correlation with fibrosis (p 0.025) and LAWT (p 0.017)Conclusion:AF is associated with significant quantifiable structural changes yet individual remodelling markers do not or only weakly correlate with each other suggesting different remodelling subtypes exist (e.g. fibrotic, hypertrophic, dilated). Structural phenotyping may provide insight in the individual AF mechanism and inform a more differentiated approach to the heterogenous AF population.

Circulation, Volume 148, Issue Suppl_1, Page A18453-A18453, November 6, 2023. Case Presentation:A 60-year-old male who presented with progressive dyspnea on exertion and atrial flutter with rapid ventricular response. His TTE showed a large (5.1 x 3.9 cm) right atrial (RA) mass occupying 80% of a severely dilated RA attached to the lateral wall (Fig A) and severe global LV hypokinesis with an ejection fraction of 20 – 25%. A TEE was then performed to further characterize this mass and showed a large (6.3 x 5.5 x 3.7 cm), heterogeneously echoreflectant, bi-lobed, and partially mobile RA mass attached to the lateral wall (Fig B,C) just below the superior vena cava and extending near the tricuspid valve annulus with sparing of the leaflets and only mild tricuspid regurgitation. At last, a chest CT scan showed a large (5.5 x 4.5 x 3.3 cm) mass which was tissue characterized as RA lipoma (Fig D). Therefore, patient underwent an uncomplicated surgical resection of the mass with partial removal of RA free wall (Fig D,E) repaired with a pericardial patch. Pathology confirmed a RA lipoma. Patient’s atrial flutter was then ablated, and patient was discharged home in stable condition.Discussion:This case illustrates an unreported cavitary giant RA lipoma inducing atrial flutter and tachycardia-mediated cardiomyopathy and emphasizes the importance of multimodality cardiac imaging in its diagnosis and management. Cardiac lipomas are rare benign tumors usually of small size and therefore mostly incidentally detected. They can rarely lead to embolization, conduction abnormalities, and flow obstruction requiring surgical resection. In this patient, pre-operative echocardiography and CT imaging were critical in the assessment of the tumor size, tissue characterization, location, motion, relation or extension to other cardiac structures, and obstruction or dysfunction of heart valves. Pre-and-intraoperative echocardiography were also essential in planning and performing the successful surgical resection of the RA lipoma.

Circulation, Volume 148, Issue Suppl_1, Page A13473-A13473, November 6, 2023. Objective:We evaluated the value of 3-dimensional (3D) fusion of SPECT myocardial perfusion imaging (MPI) with invasive coronary angiography (ICA) to guide revascularization.Methods:A retrospective observational study of 621 patients who underwent SPECT MPI and ICA. Based on the location of perfusion defect and stenosis on ICA, patients were classified into matched, unmatched, or normal groups via 3D fusion. The concordance between treatments was defined as, matched if there was revascularization in concordance with 3D fusion recommendation or if patient did not require revascularization; otherwise, they were classified as discordant. Major adverse cardiac events (MACE) (cardiac death, myocardial infarction, unstable angina requiring hospitalization or ICA, and unplanned revascularization) after revascularization of lesion recommended by 3D fusion were compared with those that the patients actually received.Results:Over a five-year follow-up period, 16% experienced MACE. Rates of MACE were 69% for matched findings, 22% for unmatched findings, 9% for normal findings (P=50%, those whose treatments were concordant with the fusion had significantly better outcomes compared to those who were not (P

Circulation, Volume 148, Issue Suppl_1, Page A12224-A12224, November 6, 2023. Introduction:Stress testing is utilized for diagnosis and risk stratification for coronary artery disease, with low-risk myocardial perfusion imaging (MPI) indicating less than 1% cardiac mortality per year. We aimed to determine the long-term cardiac mortality in these patients.Methods:We performed a retrospective observational study of 1,300 patients with low-risk MPI in 2015, including pharmacological and exercise studies in a tertiary care center in Central Massachusetts, USA. Each patient was followed from the time of the MPI study for a total duration of 7 years. All-cause mortality and cardiac death were identified. We calculated the pharmacologic and exercise MPI percentage in patients with cardiac death. A cardiac mortality graph was plotted to observe trends over seven years.Results:Out of the 1,300 patients, 3.2% [n=42; mean age 74.6+/-20 years, 78% male (n=32)] of patients had a cardiac death in the follow-up period of 7 years. The pharmacological MPI group had 5% (n=41) cardiac deaths as compared to 0.2% (n=1) in the exercise MPI with the low Duke Treadmill Score group (p-value 0.04) [Figure 1a]. The cardiac death trend over the seven years revealed the highest mortality in year 6 (19%, n= 8) and the lowest in year 4 (7.1%, n=3) [Figure 1b].Conclusions:The incidence of long-term cardiac deaths is less than 0.5% each year in patients with low-risk MPI, in both groups. Cardiac mortality was higher in patients who underwent pharmacological stress tests indicating appropriate assessment of underlying cardiac pathology. Exercise MPI depends on multiple variables to be optimal, while all patients undergoing pharmacological MPI are maximally stressed. Extensive, multi-center, controlled studies are necessary to evaluate the differences in risk stratification of low-risk MPI between exercise and pharmacological stress tests.

Circulation, Volume 148, Issue Suppl_1, Page A15527-A15527, November 6, 2023. Introduction:The clinical value of cardiac magnetic resonance (CMR) imaging-derived first-pass perfusion parameters in patients with light-chain (AL) amyloidosis remains unknown.Methods:This prospective study included 226 patients with biopsy-proven AL amyloidosis who underwent CMR between November 2011 to June 2021, with 43 healthy volunteers as normal controls. pulmonary transit time (PTT), Corrected PTT (PTTc), and pulmonary transit beats (PTB) were quantified and calculated from first-pass perfusion image. All-cause mortality was defined as the primary endpoint. Receiver operating characteristic curve, Kaplan-Meier analysis and Cox regression were used for statistical analyses.Results:PTT [area under the curve (AUC) 0.84], p

Circulation, Volume 148, Issue Suppl_1, Page A17854-A17854, November 6, 2023. Introduction:During inflammatory processes, intravascular macrophages are capable of phagocytizing circulating debris in the circulation.Hypothesis:Intravenous injection of contrast-loaded decoys could be used to label intravascular macrophages and map their distribution by non-invasive imaging.Methods:We synthetized superparamagnetic decoys with hydrodynamic diameters from 20 nm to 4.5 μm. Experimental models of neuroinflammation (intrastriatal injection of LPS or TNF) and ischemic stroke (thrombin model and ferric chloride model) were performed in mice. High resolution 3D T2*-weighted MRI sequences were performed after intravenous injection of the superparamagnetic decoys.Results:In experimental models of neuroinflammation, intravenous injection of superparamagnetic decoys with a diameter of 1 μm (but neither smaller nor larger particles) reveals intravascular phagocytic cells in the cerebral circulation, in a dose dependent manner. In ischemic stroke, we found that intravenous injection of the decoys leads to numerous signal voids in the vessels in and around the infarct core at 48 hours (Figure 1a-b). Interestingly, the intravascular phagocytic activity appears much higher in permanent rather than transient models of ischemic stroke. Pre-treatment with anti-CD11a blocking antibodies significantly reduced the number of intravascular macrophages in stroke. Histological studies confirmed that injected decoys are phagocytized by intravascular cells which express typical markers of the monocyte/macrophage lineage including CX3CR1 dependent GFP expression and CD68 (Figure 1c).Conclusions:Intravenous injection of superparamagnetic decoys in the micrometer size range allows to image intravascular macrophages. This new method allows to study the pathophysiological roles of intravascular macrophages in experimental models and could be easily translated to humans.

Circulation, Volume 148, Issue Suppl_1, Page A11731-A11731, November 6, 2023. Introduction:Intracoronary optical coherence tomography (OCT) is an imaging modality that uses near-infrared light to generate high-resolution images, and now plays an important role in research and clinical practice as it provides insights into vascular biology and diagnostic guidance for percutaneous intervention (PCI). An existing concern is that OCT imaging could increase the total amount of contrast media administered during the procedure, resulting in adverse outcomes such as impairment of renal function or worsening of heart failure in some patients.Aims:We sought to investigate whether a novel, fast-pullback, high-frequency OCT (HF-OCT) enables acquisitions with a reduced amount of contrast agents while retaining the same qualitative and quantitative lesion assessment to conventional OCT.Methods:This study is a single-center, prospective, observational study including 10 patients with stable coronary artery disease. A total of 28 individual coronary arteries were assessed by both fast-pullback HF-OCT and by conventional OCT. The fast-pullback, HF-OCT system consists of a 1.8-Fr Vis-Rx® Micro-Imaging Catheter and an HF-OCT Imaging console (Gentuity LLC, Sudbury, MA).Results:The contrast volume used in each OCT run for the HF-OCT system was significantly lower than for the conventional OCT system (5.0±0.0 vs. 7.8±0.7ml, P

Circulation, Volume 148, Issue Suppl_1, Page A16817-A16817, November 6, 2023. Introduction:Adenosine and regadenoson are commonly used vasodilators in myocardial perfusion imaging for assessment of suspected coronary artery disease.Hypothesis:The aim of this study is to determine the difference between the different vasodilators by quantifying stress and rest myocardial perfusion using cardiovascular magnetic resonance (CMR).Methods:Subjects with known or suspected CAD from 10 centers undergoing invasive coronary angiography or CT angiography were enrolled for rest and stress first-pass perfusion images using dual sequence. First-pass stress perfusion images were acquired on 1.5T or 3.0T GE scanner during adenosine or Regadenoson. Fully quantitative perfusion values were determined using Fermi deconvolution. Significant CAD was defined by: presence of≥50% stenosis in the left main coronary artery or ≥70% in the one major vessel. Diagnostic performance of stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) was measured using receiver operating characteristics curves.Results:A total of 89 subjects were recruited with a median age of 66 yrs, 69% men, 55% significant CAD, history of hypertension in 78%, diabetes in 48%, and hyperlipidemia in 74%. 36 subjects used adenosine, while 53 used regadenoson as the vasodilator agent. Stress MBF had a good area under the curve for adenosine vs. regadenoson [ 0.89 (0.78-1.00) vs. 0.82 (0.66-0.98), p=0.43], sensitivity (100% vs. 84%), and specificity (80% vs. 80%). MPR had a higher area under the curve for adenosine than regadenoson [0.87 (0.75-0.98) vs. 0.68 (0.52-0.84), p=0.06], sensitivity (100% vs. 61%), and specificity (68% vs. 73%). (Figure)Conclusions:Our study showed that fully quantitative perfusion using CMR, regadenoson, and adenosine have similar good diagnostic accuracy when stress MBF was used as the diagnostic parameter. However, adenosine outperformed regadenoson for the detection of significant CAD when MPR was used as the diagnostic parameter.

Circulation, Volume 148, Issue Suppl_1, Page A14129-A14129, November 6, 2023. Introduction:While Framingham 10-year risk scores (FRS) estimates cardiovascular disease (CVD) risk in older adults, few studies have benchmarked these estimates against age-related changes in cardiac structure and function, which are complex and highly inter-related. We investigated associations between cardiovascular (CV) imaging markers and FRS, vascular age, calculated regression, and determined connectivity between them in a network analysis.Methods:Participants recruited from a community-based cohort without CVD completed standardized questionnaires that collected baseline clinical factors, from which FRS, vascular age and calculated regression were derived. Cardiac structural and functional parameters were obtained via echocardiography.Results:202 participants (46.0% women, mean age 70.2 SD8.8) were included in this analysis. CV imaging markers correlated across a spectrum with FRS, vascular age and calculated regression. Predictive features and their associations by pearson correlation (nodes containing the variables; edges denoting links) (Fig 1) show significant associations. In ageing, this network showed that E/A ratio is inversely linked to FRS, vascular age and calculated regression while LVEF has a weak association with FRS and vascular age, without direct relationship with E/A ratio. While LAVI is associated with FRS and vascular age, LAVI is associated with E/E1 and not E/A ratio nor LVMI. Multivariate regression confirmed independent associations between FRS and vascular age with E/A ratio (b=-7.03, 95% CI -10.55, -3.52, p < 0.001; b= -15.13, 95% CI -19.33, -10.93, p < 0.001) and E/E prime ratio (b= 0.33, 95% CI 0.03 - 0.63, p = 0.033; b=0.66, 95% CI 0.30 - 1.02, p < 0.001).Conclusion:This structural collation of associations depicted different sub networks of cardiovascular imaging features into context. FRS, vascular age and calculated regression were associated with imaging markers of CV ageing at various network levels.

Circulation, Volume 148, Issue Suppl_1, Page A19087-A19087, November 6, 2023. Introduction:Duchenne muscular dystrophy (DMD), an X-linked recessive disorder affecting up to 1 in 6000. DMD-associated cardiomyopathy (DMD-C) is universal and starts as young as 6 years of age by cardiac magnetic resonance imaging (CMR) with presence of late gadolinium enhancement (LGE). Heart failure signs and symptoms are vague due to skeletal muscle myopathy. Echocardiogram only detects global dysfunction by left ventricular ejection fraction (LVEF) which rarely occur before 10 years of age. The current DMD cardiac care consideration guidelines (CCCG) recommends initiation of cardiac medication around 10 years of age or if there is LGE and/or LVEF abnormalities .Hypothesis:We hypothesized young DMD were more likely to have cardiac therapy initiated after CMR compared to only TTE evaluation.Methods:Electronic medical records for DMD patients (6 to < 10 years) who underwent routine TTE or CMR evaluation between 2014-2023 were included. Demographic data at the time of the study and initiation of cardiac medication including angiotensin-converting-enzyme inhibitor (ACE-I), Angiotensin II receptor blockers (ARB) and/or Mineralocorticoid Receptor Antagonists (MRA) were recorded.Results:150 patients met inclusion criteria, of these 81 patients underwent TTE only and 69 underwent CMR evaluation in lieu of TTE with no difference in age (8.4±1.1 versus 8.6±0.8 years, P = 0.07). Of those with TTE evaluation 10/81 (12.3%) was initiated with ACE-I or ARB ( 3/10 (33%) had LVEF < 55% (average 53.5%), 4/10 (40%) turned 10 on the follow-up visit and 3/10 (30%)) because family requested. Of the 69 patients with CMR, 51/69 (73.9%) had cardiac therapy initiated (28/51 (54.9%) because of new LGE, 6/51 (11.8%) due to isolated LVEF < 55% (average 53%), 12/51 (23.5%) would turn 10 on follow-up and 5/51 (9.8%)) the family requested. All patients with LGE on CMR also had MRA therapy started.Conclusions:DMC-C is universal and the use of CMR improved disease specific treatment of both ACE-I/ARB and MRA. Duboc et al, in a placebo control study showed that in 9.5 - 13.5 year old DMD patients treated with ACE-I had fewer patients develop dysfunction with reduced mortality at 10 years. Early and aggressive treatment may attenuate DMD-C. Future longitudinal study is needed.

Circulation, Volume 148, Issue Suppl_1, Page A16561-A16561, November 6, 2023. Introduction:The left ventricle (LV) pressure-volume loop (PV-loop) is a powerful tool for evaluating LV function. Current non-invasive cardiac MRI-based methods for estimating LV PV-loops provide limited diastolic LVP information (Circ Cardiovasc Imaging. 2019; PMID: 30630347).Aim:In this study, we introduced a new noninvasive method for PV-loop determination from cardiac MRI and noninvasive carotid pressure waveform using a physics-informed optimization method.Methods:LV volumes (LVV) were computed using short axis MRI images from a standard clinical protocol, while noninvasive carotid pressure waveforms were obtained using arterial tonometry in a clinical cohort consisting of 51 healthy and 25 heart failure (HF) participants. We formulated constraints and objective functions to optimize a time-varying LV elastance model (double-Hill) based on LVV and carotid pressure waveforms, considering LV-arterial coupling during aortic valve opening and decoupling during closure. This model allowed for individualized characterization of systolic and diastolic LV pressure and LV PV-loop.Results:In HF, our PV-loop analysis produced significantly smaller stroke work (p

Circulation, Volume 148, Issue Suppl_1, Page A15313-A15313, November 6, 2023. Background:Limited data exist regarding use of intravascular image during chronic total occlusion (CTO) intervention.Objectives:Current study investigated the prognostic impact of intravascular imaging-guided PCI in CTO lesions.Methods:Study population was derived from the RENOVATE-COMPLEX-PCI (n=1639) which demonstrated superiority of intravascular imaging-guided PCI than angiography-guided PCI in patients with complex coronary artery lesions. Current prespecified study selected patients who underwent CTO intervention and clinical outcomes were compared between intravascular imaging-guided PCI and angiography-guided PCI groups.Results:Among 1639 patients, 319 patients with CTO underwent intravascular imaging-guided PCI (n=220) or angiography-guided PCI (n=99). At a median follow-up of 2.1 years (interquartile range 1.1-3.0 years), the risk of TVF was significantly lower in intravascular imaging-guided PCI group than in the angiography-guided PCI group (5.0% vs. 13.5%; HR 0.303; 95% CI 0.130-0.710, P=0.006). When patients in imaging-guided PCI group were divided according to stent optimization, both patients with (1.3% vs. 13.5%; HR 0.14; 95% CI 0.02-0.56; P=0.003) and without (6.8% vs. 13.5%; HR 0.41; 95% CI 0.17-0.99; P=0.049) stent optimization had significantly lower risk of TVF than the angiography-guided PCI group.Conclusions:In patients with CTO, intravascular imaging-guided PCI was associated with reduced risk of TVF. Graded risk of TVF according to stent optimization by intravascular imaging supports the importance of intravascular imaging-guided PCI and achievement of stent optimization in CTO intervention.

Introduction
Pneumonic-type primary pulmonary lymphoma (PPL) is often misdiagnosed as pneumonia in clinical practice. However, this disease requires different treatments, which calls for a correct diagnosis.

Materials and methods
A total of 227 patients with pneumonic-type PPL (n=72) and pneumonia (n=155) from 7 institutions were retrospectively enrolled between January 2017 and January 2022. Clinical features (age, sex, cough, sputum, fever, haemoptysis, chest pain, smoking, weight loss and laboratory results (haemoglobin, white blood cell count, C reactive protein level and erythrocyte sedimentation rate)) and CT imaging characteristics (air bronchogram, bronchiectasis, halo sign, pleural traction, pleural effusion, lymphadenopathy, lesion maximum diameter and CT attenuation value) were analysed. Receiver operating characteristic curve analysis was performed for model construction based on independent predictors in identifying pneumonic-type PPL. In addition, we used a calibration curve and decision curve analysis to estimate the diagnostic efficiency of the model.

Results
The patients with pneumonia showed a higher prevalence of sputum, fever, leucocytosis and elevation of C reactive protein level than those with pneumonic-type PPL (p=0.002, p

Stroke, Ahead of Print. BACKGROUND:Neuroimaging is essential for detecting spontaneous, nontraumatic intracerebral hemorrhage (ICH). Recent data suggest ICH can be characterized using low-field magnetic resonance imaging (MRI). Our primary objective was to investigate the sensitivity and specificity of ICH on a 0.064T portable MRI (pMRI) scanner using a methodology that provided clinical information to inform rater interpretations. As a secondary aim, we investigated whether the incorporation of a deep learning (DL) reconstruction algorithm affected ICH detection.METHODS:The pMRI device was deployed at Yale New Haven Hospital to examine patients presenting with stroke symptoms from October 26, 2020 to February 21, 2022. Three raters independently evaluated pMRI examinations. Raters were provided the images alongside the patient’s clinical information to simulate real-world context of use. Ground truth was the closest conventional computed tomography or 1.5/3T MRI. Sensitivity and specificity results were grouped by DL and non-DL software to investigate the effects of software advances.RESULTS:A total of 189 exams (38 ICH, 89 acute ischemic stroke, 8 subarachnoid hemorrhage, 3 primary intraventricular hemorrhage, 51 no intracranial abnormality) were evaluated. Exams were correctly classified as positive or negative for ICH in 185 of 189 cases (97.9% overall accuracy). ICH was correctly detected in 35 of 38 cases (92.1% sensitivity). Ischemic stroke and no intracranial abnormality cases were correctly identified as blood-negative in 139 of 140 cases (99.3% specificity). Non-DL scans had a sensitivity and specificity for ICH of 77.8% and 97.1%, respectively. DL scans had a sensitivity and specificity for ICH of 96.6% and 99.3%, respectively.CONCLUSIONS:These results demonstrate improvements in ICH detection accuracy on pMRI that may be attributed to the integration of clinical information in rater review and the incorporation of a DL-based algorithm. The use of pMRI holds promise in providing diagnostic neuroimaging for patients with ICH.