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Archives Of Cardiovascular Imaging - Volume:4 Issue: 4, Nov 2016

Archives Of Cardiovascular Imaging
Volume:4 Issue: 4, Nov 2016

  • تاریخ انتشار: 1396/07/20
  • تعداد عناوین: 6
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  • Ali Kermani, Arash Taki, Ahmad Ayatollahi Page 1
    Background
    Thin-cap fibroatheromas (TCFAs) are the most well-known reason for plaque rupture leading to the acute coronary syndrome. Although optical coherence tomography (OCT) has the potential for use in the identification of TCFAs, the conventional analysis of this modality alone in the 2D domain is not sufficient for detecting TCFAs.
    Objectives
    The present study proposes a fully-automated method for the 3D analysis of vulnerable plaques, especially TCFAs, in OCT sequence frames.
    Methods
    A new 2-step graph-based method was used to extract the 3D morphology of the fibrous cap in an intravascular OCT image sequence. A linear cost function was applied by adding novel hard constraints. Then, an undirected graph was performed with specified edge weighting. The min-cut problem was solved for segmentation. It was divided into 2 phases: The former extracted a media region from the lumen region, and the latter extracted the fibrous cap from the media. Finally, the TCFA was extracted by the quantification of the fibrous cap thickness.
    Results
    The method was validated using 3 sets of OCT raw image sequences. The proposed method was evaluated on an OCT dataset. It was composed of 3 groups of 264 consecutive intravascular OCT frames acquired from the left coronary artery. On the real data, the lumen diameter and 3D TCFA thickness achieved 88.28% and 85.5% accuracy, respectively, in comparison with manual segmentation.
    Conclusions
    An appropriate correlation was obtained between the TCFA detected by the proposed method and the one selected manually. The proposed method was able to speed up atherosclerosis assessment; therefore, it can be used to improve the management of the acute coronary syndrome.
    Keywords: Optical Coherence Tomography, Graph, 3D Reconstruction, Thin-Cap Fibroatheroma
  • Arezou Zoroufian, Hossein Sate, Masoumeh Lotfi-Tokaldany, Mohammad Sahebjam, Hakimeh Sadeghian, Arash Jalali Page 2
    Objectives
    We aimed to compare tricuspid annular plane systolic excursion (TAPSE) by anatomical M-mode (AMM) and conventional M-mode (CMM) with right ventricular fractional area change (RV-FAC) for the evaluation of RV systolic function.
    Methods
    Between February 2013 and February 2014, 152 patients, who were admitted to our echocardiography department for the evaluation of cardiac function, were prospectively enrolled in the study. All the patients underwent CMM and 2D echocardiography and AMM echocardiography.
    Results
    The mean age of the patients was 53.27 ± 14.29 years and 52.9% were male. The patients were mostly diagnosed as having left-sided valvular disease in terms of mitral stenosis, mitral regurgitation, aortic stenosis, or aortic regurgitation (63 patients, 41.4%). Heart failure was in 18.4% and coronary artery disease in 15.8%. Among 152 patients, 17 (11.2%) had normal findings in echocardiography. Concerning RV-FAC, we categorized the patients into 3 groups: 116 patients with RV-FAC equal to or greater than 35%, 24 patients with RV-FAC between 35% and 25%, and 12 patients with RV-FAC equal to or smaller than 25%. To discriminate normal from abnormal RV-FACs (≥ 35% vs
    Conclusions
    The results of the present study on patients with a variety of cardiovascular diseases showed that TAPSE by AMM had similar specificity and sensitivity compared to TAPSE by CMM for discriminating normal from abnormal RV functions based on RV-FAC.
    Keywords: Right Ventricle, Tricuspid Valve, Anatomical M-Mode Echocardiography
  • Hamidreza Pooraliakbar, Maryam Khalili Sadrabad, Zahra Emkanjoo, Majid Haghjoo, Ahmadali Khalili Sadrabad Page 3
    Background
    Trying to reduce radiation exposure from cardiac imaging is mandatory while maintaining diagnostic image quality (IQ). Using a high-pitch spiral dual-source computed tomography (DSCT) protocol for left atrial (LA) mapping, we sought to determine IQ and radiation dose in patients with atrial fibrillation scheduled for radiofrequency ablation.
    Methods
    Fifty-nine patients (29 women; mean age = 53 y) underwent CT angiography between 2013 and 2016: 26 patients with retrospective ECG-gated (classic) and 33 with high-pitch (Flash) protocols on a second-generation 128-DSCT system (SOMATOM Definition Flash). CT images of the LA were integrated into an electroanatomic system (NavX). Two independent blinded readers evaluated IQ using a 3-point scale and the LA contrast density. Dose-length product (DLP) was obtained from each patient protocol, and effective radiation dose (ERD) was calculated according to the European guideline for CT.
    Results
    The rate of diagnostic IQ (score 3 or 2) was 87.9% for the flash group and 96.2% for the classic group, which was not significantly different between the 2 groups (P = 0.250). The results of objective IQ measurements showed that a central LA contrast density above 350 Hounsfield units (diagnostic) was present in 21 (80.8%) images in the classic group and 26 (78.8%) images in the flash group, which was not statistically different between the 2 groups (P = 0.850). There were significant differences (P
    Conclusions
    High-pitch (Flash) DSCT is an acceptable CT angiography method for reducing radiation dose without compromising IQ for LA and pulmonary venous imaging in patients with atrial fibrillation.
    Keywords: Atrial Fibrillation, Left Atrial Mapping, Dual-Source Computed Tomography, High-Pitch, Retrospective ECG-Gated, Image Quality, Radiation Dose
  • Mehmet Onur Omaygenc, Ibrahim Oguz Karaca, Beytullah Cakal, Haci Murat Gunes, Arda Ozyuksel, Cengiz Erol Page 4
    Introduction
    Giant aneurysms are extremely rare anomalies of the coronary tree. Regarding the site of involvement, the left main coronary artery (LMCA) is the least encountered of all. Coronary angiography is invariably the diagnostic method of choice but infrequently, standard injections might be inadequate to clearly opacify the distal segments. In this particular state, coronary computed tomography angiography (CCTA) offers comprehensive imaging of the entire coronary tree and the contents of the aneurysm (calcification and thrombus). CCTA may also facilitate demonstrating the mass effect of the aneurysm, if it exists.
    Case Presentation
    A 44-year-old patient on routine dialysis treatment was suspected of having significant coronary artery disease due to typical exertional symptoms and abnormal stress test results in the course of evaluation for eligibility for renal transplantation. Coronary angiography was performed, and a giant aneurysm over 4 cm in diameter possibly emerging from the LMCA, was detected. The left anterior descending artery (LAD) could not be opacified in the left coronary injections, and the coronary segments adjacent to the origin of the aneurysm were not visualized either. Therefore, a CCTA was scheduled and it illustrated not only the LAD course but also 2 other intermediate arteries that were not recognized on coronary angiography, nature of the aneurysm, and atherosclerotic burden of the entire coronary tree. The patient was treated with surgery due to proven severe myocardial ischemia and to modify the risk of the upcoming transplantation procedure. The occlusion of the branches originating from the LMCA, sac shrinkage, and bypass grafting were the consecutive steps of the selected method of heart surgery.
    Conclusions
    Comprehensive imaging of a giant coronary aneurysm is a challenging issue and utilization of different modalities, including CCTA, is essential in the majority of cases. Due to the rarity of the situation, deciding on the necessity of intervention and the method of choice are also controversial. We sought to discuss these equivocal issues in light of the limited knowledge in the existing literature.
    Keywords: Computed Tomography Angiography, Coronary Aneurysm, Coronary Angiography
  • Azin Alizadehasl, Anita Sadeghpour, Nehzat Akiash, Mahdi Peighambari, Alireza Alizadeh Ghavidel Page 5
    A 30-year-old woman was referred to our department for a cardiology visit. She had a medical history of ophthalmologic disorders. Her chief complaints were dyspnea, lightheadedness, and fainting after the Valsalva maneuver. Physical examination showed systolic murmurs at the left upper sternal border as well as corneal thinning and bulging in the 2 eyes. Transthoracic echocardiography revealed local significant hypertrophy in the base of the interventricular septum with significant left ventricular outflow obstruction and severe mitral regurgitation.
    Keywords: Keratoglobus, Hypertrophic Cardiomyopathy, LVOT Obstruction
  • Hoorak Poorzand, Farah Fani Page 6
    Introduction
    Left ventricular (LV) pseudoaneurysms due to late rupture after mitral valve replacement (MVR) are very rare. Surgical management of LV pseudoaneurysms is inevitable because of their potential risk of enlargement and rupture.
    Case Presentation
    A 53-year-old woman was referred to our echocardiography lab because of exertional dyspnea. She had recently undergone MVR and had an uneventful in-hospital course. Echocardiographic study revealed an LV pseudoaneurysm, just below the annulus in the left atrioventricular groove. She refused repeated surgery at this stage.
    Conclusions
    Rupture of the LV wall after MVR could be a fatal complication. Echocardiography is the most widely used method for the diagnosis of LV pseudoaneurysms. Cardiologists should be aware of this complication and consider it while assessing MVR cases.
    Keywords: False Aneurysm, Mitral Valve, Left Ventricle, 3D Echocardiography