Real-world experience utilizing the nuvision 4D intracardiac echocardiography catheter for left atrial appendage closure.

Transesophageal echocardiography (TEE) has been the preferred imaging modality to help guide left atrial appendage closure. Newer technologies such as the Nuvision 4D Intracardiac echocardiography (ICE) catheter allow for real-time 3D imaging of cardiac anatomy. There are no direct comparison studies for procedural imaging between TEE and 4D ICE. To evaluate the performance and safety of left atrial appendage (LAA) closure procedures with the Watchman FLX and Amulet, guided by the Nuvision 4D ICE Catheter. This retrospective observational analysis was conducted on institutional LAAO National Cardiovascular Data Registry from January 2022 to March 2023. Patients had undergone LAA closure procedures with the Watchman FLX or Amulet device guided by TEE or a 4D ICE Catheter. The primary outcome evaluated was successful LAAO device placement. A total of 121 patients underwent LAAO device placement with 46 (38.0%) patients guided by 4D ICE during LAAO implantation. The 4D ICE group had a shorter procedural time compared with TEE guidance. Post procedural 45-day TEE post implant was also comparable for both groups with no patients in either group having incomplete closure of the left atrial appendage and peri-device leak > 5 mm. No device related complications (device related access, stroke, or pericardial effusion) occurred in either group at follow-up. There was no significant difference in device implant success or post procedural outcomes at 45 days in either the TEE or 4D ICE group. However, there was a noticeable improvement in procedural time with the 4D ICE catheter.

Failure to deliver therapy by a Riata Lead with internal wire externalization and normal electrical parameters during routine interrogation.

We present a case of failure to deliver a shock by a St. Jude Medical defibrillator involving a Riata lead that was discovered incidentally while the device was attempting to deliver inappropriate therapy. Routine interrogation, including high voltage (HV) impedance, failed to reveal any abnormality. Failure to deliver therapy was confirmed during DFT testing, which revealed extremely low HV impedance only while attempting to deliver therapy. Fluoroscopy indicated moderate externalization of internal wires. This case highlights an under-recognized issue with St. Jude Medical systems, namely the possibility that therapy may not be delivered despite the presence of normal electrical parameters during routine surveillance.

Myocardial perfusion imaging and cardiovascular outcomes in a cancer population.

Myocardial perfusion imaging can predict outcomes in cardiac patients. However, limited data exist regarding its prediction of cardiovascular outcomes in cancer patients. We sought to determine whether myocardial perfusion imaging predicts long-term cardiovascular outcomes in cancer patients.We performed a retrospective review of 787 consecutive patients at our institution who underwent myocardial perfusion imaging from January 2001 through March 2003. The Cox proportional hazard model was applied, and total cardiac events, cardiac death, and all-cause death were determined for 3 years. We considered P <0.05 to be statistically significant.Patients with abnormal myocardial perfusion imaging results were more likely to be male and older, with heart disease, more vascular risk factors, and lower left ventricular ejection fraction (0.52 +/- 0.14 vs 0.63 +/- 0.11; P <0.001) than patients with normal myocardial perfusion imaging results. Multivariate predictors of total cardiac events included age (P = 0.023), hyperlipidemia (P = 0.0021), pharmacologic myocardial perfusion imaging (P <0.01), left ventricular ejection fraction (P <0.001), and abnormal myocardial perfusion imaging (P = 0.012). Multivariate predictors of cardiac death included age (P = 0.026) and left ventricular ejection fraction (P = 0.0001). Multivariate predictors of all-cause death were age (P = 0.0001), atrial fibrillation (P = 0.0012), and smoking (P <0.001). Overall survival was improved when patients took aspirin (P = 0.0002) and upon each unit increase in left ventricular ejection fraction (P <0.001).Myocardial perfusion imaging in cancer patients can predict 3-year cardiac outcomes. Increasing age, atrial fibrillation, and smoking were associated with worse outcomes, whereas higher left ventricular ejection fraction and the taking of aspirin were protective.

General utilities of multislice tomography in the cardiac field.

OBJECTS: To show all cardiac evaluations multislice computed tomography (MSCT) can perform. METHODS: MSCTs were performed on an MSCT scanner (Mx8000; Philips Medical Systems) with enhanced contrast acquisition. The reconstructed images were sent to a workstation for multiplanar reconstruction, volume rendering, and 3-D reconstruction. A total of 140 patients were studied with MSCT and conventional angiography (CA) to assess coronary artery stenosis. 30 of these patients were also evaluated by intravascular ultrasound (IVUS) for plaque characterization. A group of 20 patients were studied with MSCT, gated single-photon emission computed tomography (SPECT), and echocardiography for myocardial perfusion test and volumetric analysis. RESULTS: The results of MSCT versus CA showed a sensitivity of 79.2% and a specificity of 93.7%, whereas for MSCT versus IVUS the sensitivity was 84.4% and the specificity 91.6%. A total of 156 plaques were detected by both methods. 105 (67%) were soft, 14 (24%) were fibrous and 37 (9%) were calcified. In the evaluation of myocardial perfusion, the cardiac software showed a sensitivity of 55% and a specificity of 80%. However, general evaluation disclosed a sensitivity of 88.5% and a specificity of 96.4%. The volumetric analysis showed a good correlation between MSCT and echocardiography for end-systolic volume (ESV), rS = 0.874, and end-diastolic volume (EDV), rS = 0.828. There was also a good correlation for the evaluation of the left ventricular anatomy: septal wall rS = 0.96, posterior wall rS = 0.81, and diameter of left ventricle rS = 0.69. CONCLUSION: Nowadays, MSCT allows different cardiologic evaluations with the same acquisition as that for the coronary arteries. These data show a general view of the patient providing information that is obtained by the hand of multiple cardiologic methods such as DA, IVUS, gated SPECT, and echocardiography.

Angiografía coronaria no invasiva por tomografía computada multislice / Noninvasive coronary angiography using multislice CT

Objetivo: determinar la sensibilidad (S) y especificidad (E) de la TC multislice (TCMS) en la detección de estenosis coronaria (EC), comparándola con la angiografía digital (AD), considerada el gold standard. Material y métodos: entre marzo y junio de 2001, 50 pacientes con sospecha de enfermedad coronaria fueron estudiados por TCMS y AD. Las TC se realizaron con un equipo multislice (Mx8000; Marconi Medical Systems). Los parámetros técnicos utilizados fueron cortes de 1 mm de espesor y 0.6 mm intervalo de reconstrucción. Se realizaron los intervalos de confianza (IC) del 95 por ciento de las proporciones por el método de exacto binomial. Resultados: la S fue del 83,9 por ciento (IC: 75,5-89,9), la E del 91,2 por ciento (IC: 86,4-94,5), el valor predictivo positivo 83,2 por ciento (IC: 74,7-89,3) y el valor predictivo negativo del 91,6 por ciento (IC: 86,9-94,8). Conclusión: los resultados iniciales mostraron alta S y E de la TCMS en la detección y cuantificación de EC (AU)

Angiografía coronaria no invasiva por tomografía computada multislice / Noninvasive coronary angiography using multislice CT

Objetivo: determinar la sensibilidad (S) y especificidad (E) de la TC multislice (TCMS) en la detección de estenosis coronaria (EC), comparándola con la angiografía digital (AD), considerada el gold standard. Material y métodos: entre marzo y junio de 2001, 50 pacientes con sospecha de enfermedad coronaria fueron estudiados por TCMS y AD. Las TC se realizaron con un equipo multislice (Mx8000; Marconi Medical Systems). Los parámetros técnicos utilizados fueron cortes de 1 mm de espesor y 0.6 mm intervalo de reconstrucción. Se realizaron los intervalos de confianza (IC) del 95 por ciento de las proporciones por el método de exacto binomial. Resultados: la S fue del 83,9 por ciento (IC: 75,5-89,9), la E del 91,2 por ciento (IC: 86,4-94,5), el valor predictivo positivo 83,2 por ciento (IC: 74,7-89,3) y el valor predictivo negativo del 91,6 por ciento (IC: 86,9-94,8). Conclusión: los resultados iniciales mostraron alta S y E de la TCMS en la detección y cuantificación de EC