Efficacy of patient skin dose reduction by a compensating filter through of irradiation field overlaps on the area during percutaneous coronary intervention

Our study was involved with entrance surface dose reduction and irradiation field by the filter use of PCI, and insertion in place of an effective compensating filter to maximize entrance surface dose reduction, which we verified. The radiation dosimetry put a 6cc ion chamber on the back side of the thorax phantom, and changed the filter of the four corners (a: upper left, b: upper right, c: lower right, d: lower left) of the monitor confirmed with fluoroscopy [(0) no filter, (1) one filter, (2) two filters]. The angle of C arm was assumed to be eight directions and 0 degrees adopted by this hospital. It was compared with a corrective rate of which one was no filter. Next, the presence of filter and irradiation field overlaps on the area in monitor in the angle of C arm was verified by this hospital's classic example. As for corrective rate, (1) becomes 0.41 and (2) become 0.25 at fluoroscopy, (1) becomes 0.26 and (2) become 0.16 at exposure. Irradiation field overlaps on the area (+) compensating filter (-) was many with d of RAO/CAU, a of RAO and c of CAU at left CAG, c of LAO at right CAG, b of LAO/CRA (left CAG), b of CRA (right CAG) and a and d of RAO (right CAG) at both CAG. Irradiation field overlaps on the area (+) compensating filter (+) was many with b of CRA at left CAG, a of LAO/CRA at right CAG, b of CRA (left CAG) and b of RAO (right CAG) at both CAG. When the compensating filter is used the entrance surface dose reduction effect was great. If automatic exposure control protects the part of irradiation field overlaps on the area in the range without operating excessively, the radiological risk can be reduced, and it is conceivable as useful clinical setting.     

Determination of optimal fluoroscopic angulations for aorto-coronary ostial interventions from coronary computed tomography angiography

BackgroundAn optimal aorto-coronary angiographic projection, characterized by an orthogonal visualization of the proximal coronary artery, is crucial for interventional success. We determined the distribution of optimal C-arm positions and assessed their feasibility by invasive coronary angiography.MethodsOrthogonal aorto-coronary ostial angulations were determined in 310 CT data sets. In 100 patients undergoing subsequent invasive angiography, we assessed if the CT-predicted angulations were achievable by the C-arm system. If the predicted projection was not achievable due to mechanical constraints of the C-arm system, the most close, achievable angulation was determined. Patient characteristics were analyzed regarding the distribution of optimal angulations and its feasibility by the C-arm system.ResultsFor the left ostium, CT revealed a mean angulation of LAO 23 ?± ?21°/cranial 25 ?± ?23° (90% of patients with a LAO/cranial angulation, 3% LAO/caudal, 4% RAO/cranial, 3% RAO/caudal) and were achievable by the C-arm system in 87% of patients. For the right ostium, the mean CT-predicted orthogonal angulation was LAO 36 ?± ?37°/cranial 36 ?± ?51° (84% LAO/cranial, 2% LAO/caudal, 14% RAO/caudal) and achievable by the C-arm system in 45% of patients. For the left ostium, a higher body weight was associated with a steeper LAO/cranial angulation being less feasible by the C-arm system due to mechanical constraints.ConclusionsOrthogonal aorto-left coronary angulations show a relative narrow distribution predominately in LAO/cranial position whereas a wider range of angulations was found for the right coronary ostium. The feasibility of CT-predicted angulations by the C-arm system is more restricted for the right than the left coronary ostium.     

Feasibility of C-arm computed tomography for transcatheter aortic valve replacement planning

BackgroundThe C-arm used for fluoroscopy during transcatheter aortic valve replacement (TAVR) may also be used to acquire 3-dimensional data sets similar to multidetector row CT (MDCT).ObjectiveThe aim of this study was to evaluate the feasibility of C-arm CT (CACT) for aortic annulus and root (AoA/R) measurements in TAVR planning compared with MDCT.MethodsTwenty patients who were studied for TAVR underwent MDCT and CACT. Two independent observers measured predicted perpendicular projection to annular plane, diameters of the aortic annulus, sinus of Valsalva, sinotubular junction and ascending aorta, distance of coronary ostia to annular plane, sinus of Valsalva height, and leaflet length. Correlation between MDCT and CACT and interobserver variability were analyzed.ResultsMDCT and CACT showed strong correlation for all the measurements of the AoA/R (r ranging from 0.62 to 0.94; P between <.001 and .042) and also for the predicted perpendicular projection (left/right anterior oblique: r = 0.96, P = .002; cranial/caudal: r = 0.83, P = .043). Interobserver variability analysis showed disagreement for the measurements of the aortic annulus structures with CACT (intraclass correlation coefficient [ICC], <0.25) but not for the rest of the variables (ICC between 0.47 and 0.97). MDCT showed no interobserver variability for all the measurements (ICC between 0.45 and 0.93).ConclusionsCACT showed strong correlation with MDCT for the measurement of all AoA/R structures. However, CACT showed also important interobserver variability for the assessment of the aortic annulus. Therefore, valve sizing may not be reliably performed on the basis of CACT measurements alone.     

Aortic valve and left ventricular outflow tract calcium volume and distribution in transcatheter aortic valve replacement: Influence on the risk of significant paravalvular regurgitation

ObjectivesWe sought to determine the impact of aortic root calcium on the risk of significant paravalvular regurgitation (sPAR) in transcatheter aortic valve replacement (TAVR).MethodsIn 302 consecutive patients from 3 centers, aortic root calcium was quantified volumetrically on pre-TAVR multidetector computed tomography (MDCT) in three regions: 1) the aortic valve region, 2) the overall left ventricular outflow tract (LVOT) and 3) the upper LVOT. Transcathether heart valve (THV) oversizing was calculated as (THV nominal area/MDCT annular area−1) × 100. The study endpoint sPAR was a composite of post-dilatation (PD) and PAR > mild.ResultssPAR occurred in 15% (46/302) of patients. Upper LVOT calcium volume was more predictive of sPAR than overall LVOT calcium volume, with an area under the receiver operating curve (AUC) (95% confidence interval [CI]) of 0.80 (0.67–0.89) vs. 0.60 (0.51–0.70); p = 0.0001. The optimal cut-off calcium volume thresholds determined from receiver operating curves were 21 mm³ and 30 mm³ for upper LVOT and overall LVOT calcium, respectively. Upper LVOT calcium ≥ 21 mm³, but not overall LVOT calcium ≥ 30 mm³, independently predicted sPAR, odds ratio (95%CI): 9.5 (4.1–22.3) vs 1.6 (0.6–2.7). Upper LVOT calcium was more predictive of sPAR in patients with THV oversizing ≥ 13% compared to patients with THV oversizing <13%, AUC (95% CI): 0.83 (0.72–0.93) vs. 0.67 (0.51–0.74); p < 0.0001.ConclusionsUpper LVOT calcium predicts more-than-mild paravalvular regurgitation following TAVR or the need for postdilatation. Upper LVOT calcium is most predictive of paravalvular regurgitation in the event of THV oversizing ≥ 13%.     

Low dose contrast CT for transcatheter aortic valve replacement assessment: Results from the prospective SPECTACULAR study (spectral CT assessment prior to TAVR)

BackgroundComputed tomographic angiography (CTA) based planning for transcatheter aortic valve replacement (TAVR) is essential for reduction of periprocedural complications. Spectral CT based imaging provides several advantages, including better contrast/signal to noise ratio and increased soft tissue contrast, permitting better delineation of contrast filled structures at lower doses of iodinated contrast media. The aim of this prospective study was to assess the initial feasibility of a low dose iodinated contrast protocol, utilizing monoenergetic 40 keV reconstruction, using a dual-layer CT scanner (DLCT) for CTA in patients undergoing TAVR planning.Methods116 consecutive TAVR patients underwent a gated chest and a non-gated CTA of the abdomen and pelvis. 40 keV virtual monoenergetic images (VMI) were reconstructed and compared with conventional polychromatic images (CI). The proximal aorta and access vessels were scored for image quality by independent experienced cardiovascular imagers.ResultsProximal aortic image quality as assessed by signal to noise (SNR) and contrast to noise ratio (CNR), were significantly better with 40 keV VMI relative to CI (SNR 14.65 ± 7.37 vs 44.16 ± 22.39, p < 0.001; CNR 15.84 ± 9.93 vs 59.8 ± 40.83, p < 0.001). Aortic root dimensions were comparable between the two approaches with a bias towards higher measurements at 40 keV (Bland Altman). SNR and CNR in all access vessel segments at 40 keV were substantially better (p < 0.001 for all peripheral access vessel segments) with comparable image quality.Conclusion40 keV VMI with low dose contrast dose spectral imaging is feasible for comprehensive preprocedural evaluation of access vessels and measurements of aortic root dimensions in patients undergoing TAVR.     

Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies

Objective

To determine whether cardiac computed tomography (MDCT) can differentiate between functional and valvular aetiologies of chronic mitral regurgitation (MR) compared with echocardiography (TTE).

Methods

Twenty-seven patients with functional or valvular MR diagnosed by TTE and 19 controls prospectively underwent cardiac MDCT. The morphological appearance of the mitral valve (MV) leaflets, MV geometry, MV leaflet angle, left ventricular (LV) sphericity and global/regional wall motion were analysed. The coronary arteries were evaluated for obstructive atherosclerosis.

Results

All control and MR cases were correctly identified by MDCT. Significant differences were detected between valvular and control groups for anterior leaflet length (30?±?7 mm vs. 22?±?4 mm, P?<?0.02) and thickness (3.0?±?1 mm vs. 2.2?±?1 mm, P?<?0.01). High-grade coronary stenosis was detected in all patients with functional MR compared with no controls (P?<?0.001). Significant differences in those with/without MV prolapse were detected in MV tent area (?1.0?±?0.6 mm vs. 1.3?±?0.9 mm, P?<?0.0001) and MV tent height (?0.7?±?0.3 mm vs. 0.8?±?0.8 mm, P?<?0.0001). Posterior leaflet angle was significantly greater for functional MR (37.9?±?19.1° vs. 22.9?±?14°, P?<?0.018) and less for valvular MR (0.6?±?35.5° vs. 22.9?±?14°, P?<?0.017). Sensitivity, specificity, and positive and negative predictive values of MDCT were 100%, 95%, 96% and 100%.

Conclusion

Cardiac MDCT allows the differentiation between functional and valvular causes of MR.     

床旁防护装置对冠状动脉造影术者辐射防护效果的体模研究

目的 测量冠状动脉造影8个投照体位在有与无床旁防护装置防护下术者所受辐射剂量,为冠心病介入治疗中减少术者辐射暴露提供参考。方法 在第一及第二术者站位,距地面20至180 cm处,每隔20 cm放置一个实时剂量测量仪。采用冠状动脉造影8个体位投照,测量在有与无床旁防护装置防护下,术者在不同投照体位的不同高度接受辐射剂量情况。结果 在第一术者位,除1.2 m高度仍可测到较高剂量(剂量率0.35~4.78 mSv/h,屏蔽率27.67%~89.33%),其余各点屏蔽率均在91%以上。左前斜尾位、左前斜位、左前斜头位辐射剂量较高。第二术者位屏蔽率较第一术者位低,剂量峰值可出现在0.8、1.0及1.4 m高度(剂量率0.27~1.86 mSv/h,屏蔽率30.34%~92.13%)。右前斜尾位、左前斜尾位、正头位、左前斜位辐射剂量较高。结论 床旁防护装置防护下,术者在左前斜尾位、左前斜位、左前斜头位、右前斜尾位的辐射暴露较高,应尽量少采用上述投照体位长时间曝光。同时应加强0.8~1.4 m高度的辐射防护。     

Variables affecting the accuracy of MDCT in prediction of the proper prosthesis deployment projection for transcatheter aortic valve implantation

Objective

We evaluated multidetector computed tomography (MDCT) accuracy for the prediction of the optimal prosthetic aortic valve deployment angle in trans-catheter aortic valve implantation (TAVI) with the different variables.

Tricuspid valve anatomy of massive to torrential tricuspid regurgitation: Computed tomography analysis

BackgroundWe aimed to comprehensively assess tricuspid valve anatomy and to determine factors associated with the more advanced stages beyond severe TR (i.e., massive to torrential).MethodsWe retrospectively analyzed the pre-procedural cardiac CT images in patients with ≥severe TR using 3mensio software. The tricuspid valve annulus size, right-atrial and right-ventricular dimensions, tenting height, and leaflet angles were measured.ResultsA total of 103 patients were analyzed. The mean effective regurgitant orifice area was 61.7 ​± ​31.5 ​mm², vena contracta was 13.1 ​± ​4.6 ​mm, and massive/torrential TR was observed in 62 patients. Compared to patients with severe TR, patients with massive/torrential TR had a larger tricuspid annulus area (18.6 ​± ​3.4 ​cm² vs. 20.6 ​± ​5.3 ​cm², p ​= ​0.037), right atrial short-axis diameter (66.1 ​± ​9.1 ​mm vs. 70.6 ​± ​9.9 ​mm, p ​= ​0.022), increased tenting height (8.8 ​± ​3.6 ​mm vs. 10.7 ​± ​3.7 ​mm, p ​= ​0.014), and greater leaflet angles (anterior leaflet: 22 ​± ​9° vs. 32 ​± ​13°, p ​< ​0.001; posterior leaflet: 22 ​± ​11° vs. 30 ​± ​11°, p ​= ​0.003). In the multivariable logistic regression model, the angle of anterior leaflet (OR 1.08, 95%CI 1.03–1.14, p ​= ​0.004) and posterior leaflet (OR 1.07, 95%CI 1.02–1.13, p ​= ​0.007) were associated with massive/torrential TR. Additionally, patients with massive/torrential TR more often had TR jets from non-central/non-anteroseptal commissure (34% vs. 76%, p ​< ​0.001). In the multivariable model, a greater angle of the leaflets and a more elliptical annulus were associated with non-central/non-anteroseptal TR jets.ConclusionsAnterior and posterior leaflet angles are significant factors associated with massive/torrential TR. Furthermore, leaflet angles and ellipticity of the tricuspid valve are associated with the location of TR jets.     

Accurate estimation of global and regional cardiac function by retrospectively gated multidetector row computed tomography

Retrospective reconstruction of ECG-gated images at different parts of the cardiac cycle allows the assessment of cardiac function by multi-detector row CT (MDCT) at the time of non-invasive coronary imaging. We compared the accuracy of such measurements by MDCT to cine magnetic resonance (MR). Forty patients underwent the assessment of global and regional cardiac function by 16-slice MDCT and cine MR. Left ventricular (LV) end-diastolic and end-systolic volumes estimated by MDCT (134±51 and 67±56 ml) were similar to those by MR (137±57 and 70±60 ml, respectively; both P=NS) and strongly correlated (r=0.92 and r=0.95, respectively; both P<0.001). Consequently, LV ejection fractions by MDCT and MR were also similar (55±21 vs. 56±21%; P=NS) and highly correlated (r=0.95; P<0.001). Regional end-diastolic and end-systolic wall thicknesses by MDCT were highly correlated (r=0.84 and r=0.92, respectively; both P<0.001), but significantly lower than by MR (8.3±1.8 vs. 8.8±1.9 mm and 12.7±3.4 vs. 13.3±3.5 mm, respectively; both P<0.001). Values of regional wall thickening by MDCT and MR were similar (54±30 vs. 51±31%; P=NS) and also correlated well (r=0.91; P<0.001). Retrospectively gated MDCT can accurately estimate LV volumes, EF and regional LV wall thickening compared to cine MR. Grant funding: Dr. Belge was supported by a fellowship of the Fondation Nationale de la Recherche Scientifique of the Belgian government. Dr. Gerber was supported by a grant from the Fondation Nationale de la Recherche Scientifique of the Belgian government (FRSM 3.4557.02).     

Measurement of coronary artery bifurcation angles by multidetector computed tomography

OBJECTIVE: Optimal stent deployment in coronary artery bifurcations requires information about the angle between main vessel and side branch. We evaluated the accuracy and interobserver variability of bifurcation angle measurements by contrast-enhanced 16-slice multidetector computed tomography (MDCT) in comparison with invasive angiography and examined the average angles of 4 main coronary bifurcations. METHODS: To determine the accuracy of MDCT for measurement of bifurcation angles, we scanned a coronary artery phantom containing 6 bifurcations (2-mm metal rods with angles between 25 degrees and 90 degrees ) using MDCT, and angles determined in the MDCT data set were compared with the true values. To assess interobserver variability of angle measurements in comparison to invasive angiography, the angles of 3 bifurcation sites (left anterior descending and left circumflex coronary artery [LAD/LCX], LAD and first diagonal branch [LAD/Diag 1], and posterior descending coronary artery and right posterolateral branch [PDA/Rpld]) were determined in 15 patients both in 16-detector row MDCT data sets and invasive coronary angiograms by 2 independent observers each. To assess the natural distribution of the 4 main coronary artery bifurcation angles (LAD and LCX, LAD and Diag 1, LCX and OM1, PDA and Rpld), the average angles of these bifurcations were determined in 16-slice MDCT data sets acquired for coronary artery visalization in a group of 100 consecutive patients with suspected coronary artery disease. RESULTS: The phantom study revealed a mean difference between measured and true angles of 0.7 +/- 0.5 degrees . In the comparison MDCT versus invasive angiography, the 45 angles were significantly lager in MDCT (mean: 66 +/- 20 degrees vs. 56 +/- 24 degrees , P = 0.027). Interobserver variability was significantly lower in MDCT (r = 0.91) than invasive angiography (r = 0.62). Analysis of the natural distribution of bifurcation angles by MDCT revealed average values of 80 +/- 27 degrees (LAD/LCX), 46 +/- 19 degrees (LAD/Diag1), 48 +/- 24 degrees (LCX/OM1), and 53 +/- 27 degrees (PDA/Rpld), respectively. CONCLUSION: MDCT allows assessment of coronary bifurcation angles with high accuracy, which may be of future potential for planning interventional treatment.     

Aortic valve and aortic root features in CT angiography in patients considered for aortic valve repair

BackgroundThe underlying mechanism of aortic regurgitation and aortic valve and root characteristics are associated with the durability of surgical repair.ObjectiveWe investigated whether multidetector CT (MDCT) identifies the characteristics of the aortic valve and root that may be associated with the ability to perform successful surgical repair.MethodsSixty-one patients with aortic regurgitation and/or aortic root pathology who were evaluated for aortic valve or root repair and underwent clinically indicated gated or nongated MDCT of the aortic valve and aortic root were included in the present analysis. Patients with endocarditis were excluded. MDCT data of aortic valve anatomy and calcification and thoracic aorta dimensions were analyzed.ResultsThe aortic valve and root was successfully repaired in 36 patients (55 ± 13 years; 61% male; median EuroSCORE II, 3.8%) whereas in 25 patients (56 ± 15 years; 52% male; median EuroSCORE II, 2.5%) repair was not attempted (n = 20) or valve repair was converted to aortic valve replacement during surgery (n = 5). In patients in whom repair was considered not possible or failed, there was a higher percentage of bicuspid aortic valves (48% vs 17%; P = .019), more severe commissural calcification, and more severe annular calcification.ConclusionThe degree of commissural and annular calcification of the aortic valve determined by MDCT is inversely related to the ability to perform surgical valve repair instead of replacement. Similarly, bicuspid valve anatomy predicts failure to perform repair.     

Effect of the ellipsoid shape of the left ventricular outflow tract on the echocardiographic assessment of aortic valve area in aortic stenosis

BackgroundPrevious studies showed discrepancies between echocardiographic and multidector row CT (MDCT) measurements of aortic valve area (AVA).ObjectiveOur aim was to evaluate the effect of the ellipsoid shape of the left ventricular outflow tract (LVOT), as shown and measured by MDCT, on the assessment of AVA by transthoracic echocardiography (TTE) in patients with severe aortic stenosis.MethodsThis retrospective single-center study involved 49 patients with severe aortic stenosis referred before transcatheter aortic valve implantation. The AVA was deduced from the continuity equation on TTE and from planimetry on cardiac MDCT. Area of the LVOT was calculated as follows: on TTE, from the measurement of LVOT diameter on parasternal long-axis view; on MDCT, from manual planimetry by using multiplanar reconstruction perpendicular to LVOT.ResultsAt baseline, correlation of TTE vs MDCT AVA measurements was moderate (R = 0.622; P < .001). TTE underestimated AVA compared with MDCT (0.66 ± 0.15 cm² vs 0.87 ± 0.15 cm²; P < .001). After correcting the continuity equation with the LVOT area as measured by MDCT, mean AVA drawn from TTE did not differ from MDCT (0.86 ± 0.2 cm²) and correlation between TTE and MDCT measurements increased (R = 0.704; P < .001).ConclusionAssuming that LVOT area is circular with TTE results in constant underestimation of the AVA with the continuity equation compared with MDCT planimetry. The elliptical not circular shape of LVOT largely explains these discrepancies.     

Patient-specific computer simulation to predict long-term outcomes after transcatheter aortic valve replacement

BackgroundPatient-specific computer simulation may predict the development of paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). We hypothesised that patient-specific computer simulation might identify patients at risk for long-term adverse outcomes after TAVR.MethodsA multi-centre retrospective study was performed on patients with symptomatic severe aortic stenosis who had undergone TAVR with a self-expanding transcatheter heart valve (THV). Pre-procedural cardiac computed tomography imaging was used to create finite element models of the aortic root. Finite element analysis (FEA) was performed in order to simulate the interaction between the THV and the native anatomy. The blood domain was extracted from the FEA output and computational fluid dynamics (CFD) simulation undertaken. Predicted PVR was recorded in the left ventricular outflow tract. Patients were classified into those where computer simulation predicted no significant PVR (predicted PVR from CFD <16.0 ?mL/s) and those where computer simulation predicted significant PVR (predicted PVR from CFD ≥16.0 ?mL/s).ResultsA total of 203 patients were included in the study. THVs implanted were CoreValve (n ?= ?20), Evolut R (n ?= ?90) and Evolut PRO (n ?= ?93). At 2 years, the Kaplan-Meier estimate of the rate of death from any cause was higher in the group where CFD simulation predicted significant PVR (35.8% vs. 16.3%; hazard ratio, 2.62; 95% confidence interval, 1.29 to 5.30; P ?= ?0.006 by log-rank test).ConclusionsComputer simulation may identify patients who are at a higher risk for death after TAVR.     

Short membranous septum length in bicuspid aortic valve stenosis increases the risk of conduction disturbances

BackgroundDistinct anatomical features predispose bicuspid AS patients to conduction disturbances after TAVR. This study sought to evaluate whether the incidence of permanent pacemaker implantation (PPMI) and left bundle branch block (LBBB) in patients with bicuspid aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR) is related to an anatomical association between bicuspid AS and short membranous septal (MS) length.MethodsSixty-seven consecutive patients with bicuspid AS from a Bicuspid AS TAVR multicenter registry and 67 propensity-matched patients with tricuspid ASunderwent computed tomography before TAVR.ResultsMS length was significantly shorter in bicuspid AS compared with tricuspid AS (6.2 ± 2.5 mm vs. 8.4 ± 2.7 mm, respectively; p < 0.001). In patients with bicuspid AS, MS length and aortic valve calcification were the most powerful pre-procedural independent predictors of PPMI or LBBB (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.15 to 1.55, p = 0.003 and OR: 1.92, 95% CI: 1.1 to 3.34, p = 0.022, respectively). When taking into account pre- and post-procedural parameters, aortic valve calcification and the difference between MS length and implantation depth were the most powerful independent predictors of PPMI or LBBB in patients with bicuspid AS (OR: 1.82, 95%: 1.1 to 3.1, p = 0.027; OR: 1.25, 95% CI: 1.10 to 1.38, p = 0.003).ConclusionMS length, which was significantly shorter in bicuspid AS compared with tricuspid AS, aortic valve calcification, and device implantation deeper than MS length predict PPMI or LBBB in bicuspid AS after TAVR.     

Coronary ostial eccentricity in severe aortic stenosis: Guidance for BASILICA transcatheter leaflet laceration

BackgroundEccentricity of coronary ostial positions in relation to the aortic valve cusp may influence the target laceration location in BASILICA (Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Coronary Artery obstruction). Eccentricity of the coronary ostia in relation to coronary cusps of native and valve-in-valve transcatheter aortic valve replacement (TAVR) was not well described before.MethodsA total of 121 pre-TAVR patients’ CT data (72 native valves TAVR and 49 bioprosthetic surgical valves TAVR) was included and coronary ostial eccentricity angles were measured and compared. Coronary ostial angles were measured between mid-cusp line to coronary ostium in CT perpendicular images.ResultsIn the overall cohort, the right coronary artery (RCA) had an eccentric origin in the majority of cases, favoring the commissure between the right and the non coronary cusp (17.0°, IQR; 10–25). On the other hand, the left coronary artery (LCA) originated most commonly near center of the cusp position (0°, IQR; -8 -7.5) In comparison of native and bioprosthetic valves, RCA ostial angles were more eccentric in native valves (19.0°, IQR; 12–26) than in bioprosthetic valves (14.0°, IQR; 3–20) (p = 0.004). Whereas, LCA ostial angle has no significant differences between native valves (−2.0°, IQR;-7.75-5.75) and bioprosthetic valves (1°, IQR;-8-13), (p = 0.6).ConclusionRCA ostia often have an eccentric origin towards the non-coronary cusp, especially in native aortic valves, while LCA ostia commonly originate near the center of the cusp. This finding may contribute to better performance of BASILICA procedures.     

The predictive value of cardiac morphology for long-term outcome of patients undergoing catheter ablation for atrial fibrillation

ObjectiveCatheter ablation (CA) is an established therapy for selected patients with atrial fibrillation (AF), but predictors of CA ablation outcome are still not fully elucidated. The aim of the study was to identify structural and morphological parameters from computed tomography (CT) as predictors of successful CA of AF in a single center prospective cohort.MethodsAn analysis of CT scans dedicated to LA evaluation was performed in 99 patients (63 ± 8 years old, 70% males, 59% paroxysmal AF) scheduled for CA of AF. Survival free of atrial fibrillation/flutter/tachycardia at 1- and 3-years was assessed.ResultsIn overall study population, both 1- and 3-year responders had smaller distance to the first division in left superior pulmonary vein (16.3 ± 5.42 mm vs. 19.1 ± 7.0 mm and 14.9 ± 3.6 mm vs. 18.7 ± 7.0 mm; p < 0.05). One-year responders had larger ostium area of left inferior pulmonary vein (median 236 mm² [IQR = 97] vs. 222 mm² [IQR = 71]; p = 0.03) and less acute angle between the interatrial septum and the right superior pulmonary vein (102 ± 20° vs. 95 ± 10°; p = 0.03). Three-years' responders had smaller ostium area of the right superior pulmonary vein (248 ± 94 mm² vs. 364 ± 282 mm²; p = 0.02). Multivariate Cox regression analysis identified different predictors in paroxysmal and non-paroxysmal AF. For patients with paroxysmal AF, the predictors were angle to right superior pulmonary vein and left superior/inferior pulmonary veins carina thickness with hazard ratios of 0.965 (95%CI 0.939 to 0.992, p = 0.010) and 0.747 (95%CI 0.591 to 0.944, p = 0.015). In patients with persistent AF, the predictors were gender and NYHA stage with hazard ratios of 4.9 (95%CI 1.758 to 13.579, p = 0.002) and 0.365 (95%CI 0.148 to 0.899, p = 0.028) respectively.ConclusionsThe anatomy of LA, especially morphology of pulmonary veins, seems to be one of the predictors of clinical outcome after CA for paroxysmal AF. In non-paroxysmal AF LA anatomy is less relevant in prediction of clinical outcome.     

MR findings associated with positive distraction of the hip joint achieved by axial traction

Purpose

To determine which MR-arthrography findings are associated with positive hip joint distraction.

Materials and methods

One hundred patients with MR arthrography of the hip using axial traction were included. Traction was applied during the MR examination with an 8 kg (females) or 10 kg (males) water bag, attached to the ankle over a deflection pulley. Fifty patients showing joint space distraction were compared to an age- and gender-matched control group of 50 patients that did not show a joint distraction under axial traction. Two radiologists assessed the neck-shaft angle, lateral and anterior center-edge (CE) angles, CE angles in the transverse plane, extrusion index of the femoral head, acetabular depth, alpha angle, acetabular version, ligamentum teres, joint capsule and ligaments, iliopsoas tendon and the labrum.

Results

Mean joint space distraction in the study group was 0.9?±?0.6 mm. Patients with positive joint space distraction had significantly higher neck-shaft angles (control group 131.6?±?5.4°/study group 134.1?±?6.1°, p?<?0.05), smaller lateral CE angles (38.1?±?5.9°/34.6?±?7.2°, p?<?0.05), smaller overall transverse CE angles (161.4?±?9.9°/153.6?±?9.6°, p?<?0.001), smaller acetabular depth (4.1?±?2.4 mm/5.8?±?2.5 mm, p?<?0.01), higher alpha angles (53.5?±?7.8°/59.2?±?10.1°, p?<?0.01) and a thicker ligamentum teres (4.7?±?1.4 mm/5.4?±?1.8 mm, p?<?0.05). The other parameters revealed no significant differences. ICC values for interobserver agreement were 0.71–0.95 and kappa values 0.43–0.92.

Conclusion

Increased neck-shaft angles, small CE angles, small acetabular depth, higher alpha angles and a thick ligamentum teres are associated with positive joint distraction.

     

Metabolic testing does not alter distance running lower body sagittal kinematics

BackgroundDistance running fitness is commonly assessed using metabolic testing (MT). During MT, the runner must wear a mask that covers the nose and mouth. It is unclear if this increased challenge alters running kinematics and/or stride-to-stride variability (SSV). In this study we thoroughly assess the sagittal plane lower body joint angles.Research questionAre there significant differences between standard treadmill running kinematics and those collected during MT?MethodsTwenty recreational runners participated (34.8 ± 10.0 years; 20+ miles per week). Six Vicon Bonita cameras were used to collect kinematic data (200 Hz). A metabolic cart (Parvo Medics TrueOne 2400) was used for heart rate (HR) collection and testing. Participants ran 4 × 4 min at preferred pace: 2 control runs (CON) and 2 MT runs. Ten strides were used to generate average stance and swing joint angle plots. The phase plots were compared for CON and MT and mean difference scores were calculated (to determine the kinematic change). SSV was determined by assessing the standard deviations among the 10 strides. Repeated measures ANOVA was used to test for significant differences among CON and MT trials. Reliability was assessed for 8 discrete joint angles using ICC analysis.ResultsThere were no significant differences between CON and MT for both the joint angle plot comparisons and SSV. For the discrete kinematic measures, ICC scores were strong (0.89-0.99) between CON and MT. During MT, there were slight increases (p < 0.01) in HR (145 ± 14 vs. 147 ± 14) and RPE (10.4 ± 1.5 vs. 11.4 ± 1.5).SignificanceResults from this study support the validity of simultaneously conducting a kinematic and MT analysis. However, clinicians and performance coaches should be aware that 1) MT is slightly more physiologically demanding than CON and 2) approaches from this study can be used during individual assessments to confirm that kinematics are similar (between CON and MT).