ABSTRACT
The diagnostic evaluation of coronary artery disease is undergoing a dramatic transformation with a new focus on atherosclerotic plaque. This review details the evidence needed for effective risk stratification and targeted preventive care based on recent advances in automated measurement of atherosclerosis from coronary computed tomography angiography (CTA). To date, research findings support that automated stenosis measurement is reasonably accurate, but evidence on variability by location, artery size, or image quality is unknown. The evidence for quantification of atherosclerotic plaque is unfolding, with strong concordance reported between coronary CTA and intravascular ultrasound measurement of total plaque volume (r >0.90). Statistical variance is higher for smaller plaque volumes. Limited data are available on how technical or patient-specific factors result in measurement variability by compositional subgroups. Coronary artery dimensions vary by age, sex, heart size, coronary dominance, and race and ethnicity. Accordingly, quantification programs excluding smaller arteries affect accuracy for women, patients with diabetes, and other patient subsets. Evidence is unfolding that quantification of atherosclerotic plaque is useful to enhance risk prediction, yet more evidence is required to define high-risk patients across varied populations and to determine whether such information is incremental to risk factors or currently used coronary computed tomography techniques (eg, coronary artery calcium scoring or visual assessment of plaque burden or stenosis). In summary, there is promise for the utility of coronary CTA quantification of atherosclerosis, especially if it can lead to targeted and more intensive cardiovascular prevention, notably for those patients with nonobstructive coronary artery disease and high-risk plaque features. The new quantification techniques available to imagers must not only provide sufficient added value to improve patient care, but also add minimal and reasonable cost to alleviate the financial burden on our patients and the health care system.
Subject(s)
Atherosclerosis , Coronary Artery Disease , Plaque, Atherosclerotic , Humans , Female , Coronary Artery Disease/diagnostic imaging , Computed Tomography Angiography , Coronary Angiography/methods , Constriction, Pathologic , Predictive Value of Tests , Coronary Vessels/diagnostic imaging , Risk AssessmentABSTRACT
While in labor, a 37-year-old woman developed acute dyspnea, hypoxemia, and tachycardia. Transthoracic echocardiography demonstrated severe right ventricular dilation and dysfunction, raising the suspicion of acute pulmonary embolism. The patient indeed had bilateral pulmonary embolism, necessitating percutaneous thrombectomy. Her course was complicated by another saddle pulmonary embolus, heparin-induced thrombocytopenia, and COVID-19 infection. This clinical case illustrates the importance of prompt diagnosis of acute pulmonary embolism in a peripartum female patient, the multidisciplinary approach of management, and how to approach clinical complications such as heparin-induced thrombocytopenia. Furthermore, long-term management in acute pulmonary embolism is presented.
ABSTRACT
While in labor, a 37-year-old woman developed acute dyspnea, hypoxemia, and tachycardia. Transthoracic echocardiography demonstrated severe right ventricular dilation and dysfunction, raising the suspicion of acute pulmonary embolism. The patient indeed had bilateral pulmonary embolism, necessitating percutaneous thrombectomy. Her course was complicated by another saddle pulmonary embolus, heparin-induced thrombocytopenia, and COVID-19 infection. This clinical case illustrates the importance of prompt diagnosis of acute pulmonary embolism in a peripartum female patient, the multidisciplinary approach of management, and how to approach clinical complications such as heparin-induced thrombocytopenia. Furthermore, long-term management in acute pulmonary embolism is presented.
Subject(s)
COVID-19 , Pulmonary Embolism , Thrombocytopenia , Humans , Female , Adult , Critical Pathways , COVID-19/complications , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Echocardiography , Acute DiseaseSubject(s)
American Heart Association , Chest Pain , Humans , Predictive Value of Tests , United StatesABSTRACT
A 19-year-old female patient presented with Staphylococcus aureus infective endocarditis, with suspected subdural brain hemorrhage, disseminated intravascular coagulopathy, and septic renal as well as spleen infarcts. The patient had extensive vegetations on the mitral and tricuspid valves and underwent urgent mitral and tricuspid repair. This paper discusses the clinical case and current evidence regarding the management and treatment of Staphylococcus aureus endocarditis.
ABSTRACT
A 19-year-old female patient presented with Staphylococcus aureus infective endocarditis, with suspected subdural brain hemorrhage, disseminated intravascular coagulopathy, and septic renal as well as spleen infarcts. The patient had extensive vegetations on the mitral and tricuspid valves and underwent urgent mitral and tricuspid repair. This paper discusses the clinical case and current evidence regarding the management and treatment of Staphylococcus aureus endocarditis.
Subject(s)
Endocarditis, Bacterial/microbiology , Staphylococcal Infections/diagnosis , Electrocardiography , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/surgery , Female , Heart Valve Prosthesis Implantation , Humans , Incidental Findings , Lung/diagnostic imaging , Lupus Erythematosus, Systemic/diagnosis , Mitral Valve/microbiology , Mitral Valve/surgery , Staphylococcal Infections/surgery , Staphylococcus aureus , Tricuspid Valve/surgery , Young AdultSubject(s)
Diagnostic Imaging , Plaque, Atherosclerotic , Biology , Humans , Predictive Value of TestsSubject(s)
Medical Oncology , Neoplasms , Humans , Neoplasms/diagnostic imaging , Neoplasms/therapy , Predictive Value of TestsSubject(s)
Artificial Intelligence , Trust , Cardiac Imaging Techniques , Humans , Predictive Value of TestsABSTRACT
Coronary computed tomographic angiography (CCTA) provides a wealth of clinically meaningful information beyond anatomic stenosis alone, including the presence or absence of nonobstructive atherosclerosis and high-risk plaque features as precursors for incident coronary events. There is, however, no uniform agreement on how to identify and quantify these features or their use in evidence-based clinical decision-making. This statement from the Society of Cardiovascular Computed Tomography and North American Society of Cardiovascular Imaging addresses this gap and provides a comprehensive review of the available evidence on imaging of coronary atherosclerosis. In this statement, we provide standardized definitions for high-risk plaque (HRP) features and distill the evidence on the effectiveness of risk stratification into usable practice points. This statement outlines how this information should be communicated to referring physicians and patients by identifying critical elements to include in a structured CCTA report - the presence and severity of atherosclerotic plaque (descriptive statements, CAD-RADS™ categories), the segment involvement score, HRP features (e.g., low attenuation plaque, positive remodeling), and the coronary artery calcium score (when performed). Rigorous documentation of atherosclerosis on CCTA provides a vital opportunity to make recommendations for preventive care and to initiate and guide an effective care strategy for at-risk patients.
Subject(s)
Computed Tomography Angiography/standards , Coronary Angiography/standards , Coronary Artery Disease/diagnostic imaging , Coronary Vessels/diagnostic imaging , Plaque, Atherosclerotic , Consensus , Humans , Predictive Value of Tests , Prognosis , Reproducibility of Results , Risk Assessment , Risk Factors , Rupture, Spontaneous , Severity of Illness IndexSubject(s)
Atrial Appendage , Atrial Fibrillation , Septal Occluder Device , Atrial Appendage/diagnostic imaging , Cardiac Catheterization/adverse effects , Cardiac Catheterization/methods , Conscious Sedation , Echocardiography/methods , Echocardiography, Transesophageal , Humans , Predictive Value of Tests , Treatment OutcomeSubject(s)
COVID-19 , Pandemics , Cardiac Imaging Techniques , Diagnostic Imaging , Humans , SARS-CoV-2Subject(s)
Cardiovascular Diseases/diagnostic imaging , Coronavirus Infections/epidemiology , Infectious Disease Transmission, Vertical/prevention & control , Multimodal Imaging/methods , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Safety Management/methods , COVID-19 , Cardiac Imaging Techniques/methods , Coronavirus Infections/prevention & control , Echocardiography, Transesophageal/methods , Echocardiography, Transesophageal/trends , Female , Forecasting , Humans , Infection Control/organization & administration , Magnetic Resonance Imaging, Cine/methods , Magnetic Resonance Imaging, Cine/trends , Male , Occupational Health , Pandemics/prevention & control , Patient Safety , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/prevention & control , Safety Management/trends , United StatesABSTRACT
Since its inception in 2008, JACC: Cardiovascular Imaging (iJACC) has served as an important publication for all contemporary aspects of cardiovascular imaging. Understanding the dissemination trends in cardiovascular imaging has traditionally been evaluated through citations that assess interest in the research community. Recently, social media, alternative metrics (Altmetrics), and other modern metrics have enabled a more broader understanding of the interests of clinical readership. Through the prism of Altmetrics, this review discusses the most impactful studies across the spectrum of cardiovascular imaging within and outside of iJACC during a 3-year period (2017 to 2019). The top 100 Altmetrics iJACC articles in this timeframe, included articles with the highest impact with the combination of high Altmetrics (median: 66; interquartile range [IQR]: 56 to 108), high citations (median: 26; IQR: 17 to 34), and high downloads (median: 9,626; IQR: 5,770 to 11,435). This review aims to provide a framework to understand how to incorporate these metrics for a modern approach to dissemination of knowledge in the field of cardiovascular imaging.
Subject(s)
Cardiac Imaging Techniques , Cardiovascular Diseases/diagnostic imaging , Bibliometrics , Humans , Journal Impact Factor , Periodicals as Topic , Predictive Value of Tests , Social MediaABSTRACT
The 2016 National Institute of Health and Care Excellence clinical guideline for the assessment and diagnosis of chest pain positions coronary computed tomography angiography as the first test for all stable chest pain patients without confirmed coronary artery disease and discards the previous emphasis on calculation of pre-test likelihood recommended in their 2012 edition of the guidelines. On the other hand, the American College of Cardiology Foundation/American Heart Association and the European Society of Cardiology guidelines continue to present the stress testing functional modalities as the tests of choice. The aim of this review is to present, in the form of a debate, the pros and cons of these paradigm changing recommendations, with an emphasis on literature review and projection of future needs, with conclusions to be drawn by the reader.