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Editorial

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Open AccessEditorial

Biomedical Imaging Technologies for Cardiovascular Disease - Volume II

by Julio Garcia

Appl. Sci. 2024, 14(5), 1688; https://doi.org/10.3390/app14051688 - 20 Feb 2024

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Abstract

Biomedical imaging innovation facilitates a better understanding of the heart’s physiology, performance, function, and structure [...] Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

Research

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14 pages, 3183 KiB

Open AccessArticle

Characterization of Cardiac Fat in Atrial Fibrillation Patients Prior to Ablation Treatment

by Feham Peer-Zada, Dima Hamze and Julio Garcia

Appl. Sci. 2023, 13(21), 12005; https://doi.org/10.3390/app132112005 - 3 Nov 2023

Viewed by 781

Abstract

Epicardial adipose tissue (EAT) and pericardial adipose tissue (PAT) contribute to the development of left atrial fibrillation (AF). The purpose of this study is to determine the factors influencing cardiac fat, evaluate its impact on heart function, and evaluate its role in the [...] Read more.

Epicardial adipose tissue (EAT) and pericardial adipose tissue (PAT) contribute to the development of left atrial fibrillation (AF). The purpose of this study is to determine the factors influencing cardiac fat, evaluate its impact on heart function, and evaluate its role in the recurrence of AF. Cardiac MRI exams of n = 198 patients with paroxysmal AF were retrospectively analyzed to quantify EAT and PAT. Body mass index (BMI) showed significant associations with increased EAT, PAT, and total cardiac fat, particularly with the total end-systolic area (p < 0.001). Males were associated with increased PAT (r = −0.331, p < 0.001) and EAT (r = −0.168, p = 0.019). Increased PAT end-diastolic volume was also associated with an increase in LV mass (r = 0.249, p < 0.01). An inverse relationship between EAT end-systolic area and cardiac index (r = −0.220, p < 0.01) was observed. Although BMI did not significantly affect AF recurrence, overweight patients (36%) experienced slightly more AF recurrence than obese patients (33%). Obesity is substantially associated with an increase in EAT and PAT, while sex appears to play a greater role in PAT than EAT and decreased cardiac function. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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21 pages, 7884 KiB

Open AccessArticle

Explainable Deep Fuzzy Cognitive Map Diagnosis of Coronary Artery Disease: Integrating Myocardial Perfusion Imaging, Clinical Data, and Natural Language Insights

by Anna Feleki, Ioannis D. Apostolopoulos, Serafeim Moustakidis, Elpiniki I. Papageorgiou, Nikolaos Papathanasiou, Dimitrios Apostolopoulos and Nikolaos Papandrianos

Appl. Sci. 2023, 13(21), 11953; https://doi.org/10.3390/app132111953 - 1 Nov 2023

Cited by 4 | Viewed by 1265

Abstract

Myocardial Perfusion Imaging (MPI) has played a central role in the non-invasive identification of patients with Coronary Artery Disease (CAD). Clinical factors, such as recurrent diseases, predisposing factors, and diagnostic tests, also play a vital role. However, none of these factors offer a [...] Read more.

Myocardial Perfusion Imaging (MPI) has played a central role in the non-invasive identification of patients with Coronary Artery Disease (CAD). Clinical factors, such as recurrent diseases, predisposing factors, and diagnostic tests, also play a vital role. However, none of these factors offer a straightforward and reliable indication, making the diagnosis of CAD a non-trivial task for nuclear medicine experts. While Machine Learning (ML) and Deep Learning (DL) techniques have shown promise in this domain, their “black-box” nature remains a significant barrier to clinical adoption, a challenge that the existing literature has not yet fully addressed. This study introduces the Deep Fuzzy Cognitive Map (DeepFCM), a novel, transparent, and explainable model designed to diagnose CAD using imaging and clinical data. DeepFCM employs an inner Convolutional Neural Network (CNN) to classify MPI polar map images. The CNN’s prediction is combined with clinical data by the FCM-based classifier to reach an outcome regarding the presence of CAD. For the initialization of interconnections among DeepFCM concepts, expert knowledge is provided. Particle Swarm Optimization (PSO) is utilized to adjust the weight values to the correlated dataset and expert knowledge. The model’s key advantage lies in its explainability, provided through three main functionalities. First, DeepFCM integrates a Gradient Class Activation Mapping (Grad-CAM) algorithm to highlight significant regions on the polar maps. Second, DeepFCM discloses its internal weights and their impact on the diagnostic outcome. Third, the model employs the Generative Pre-trained Transformer (GPT) version 3.5 model to generate meaningful explanations for medical staff. Our dataset comprises 594 patients, who underwent invasive coronary angiography (ICA) at the department of Nuclear Medicine of the University Hospital of Patras in Greece. As far as the classification results are concerned, DeepFCM achieved an accuracy of 83.07%, a sensitivity of 86.21%, and a specificity of 79.99%. The explainability-enhancing methods were assessed by the medical experts on the authors’ team and are presented within. The proposed framework can have immediate application in daily routines and can also serve educational purposes. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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13 pages, 849 KiB

Open AccessArticle

Improved Cardiac Performance with Dexamethasone Therapy in Premature Neonates: Novel Insights Using Serial Echocardiographic Assessments

by Jejelola Ladele, Ayman Saker, Talal Altamimi, Andrea De La Hoz, Renjini Lalitha, Michael R. Miller and Soume Bhattacharya

Appl. Sci. 2023, 13(20), 11380; https://doi.org/10.3390/app132011380 - 17 Oct 2023

Viewed by 904

Abstract

(1) Background: dexamethasone is used for the prevention and treatment of chronic lung disease (CLD) in premature neonates, and its impact on cardiac performance and pulmonary vascular resistance has not been well studied. (2) Methods: eligible neonates of <30 weeks gestational age (GA) [...] Read more.

(1) Background: dexamethasone is used for the prevention and treatment of chronic lung disease (CLD) in premature neonates, and its impact on cardiac performance and pulmonary vascular resistance has not been well studied. (2) Methods: eligible neonates of <30 weeks gestational age (GA) had echocardiograms performed on them at three time points—before the initiation of dexamethasone (Echo-1), 24–48 h post the completion of dexamethasone therapy (Echo-2), and 7–14 days after course completion (Echo-3). (3) Results: 28 neonates with a 25.2 week mean GA and 652.9 g birthweight were included. The mean cumulative dose of dexamethasone was 0.98 mg/kg, given over 8–10 days. Echo-1 and Echo-2 showed a significant improvement in the right ventricular fractional area change (RV FAC 44.88 vs. 49.71, p = 0.025), tricuspid annular plane systolic excursion (TAPSE 0.65 cm vs. 0.70 cm, p = 0.013), and RV S’ (7.18 vs. 8.56, p = 0.05). The left ventricular (LV) ejection fraction was similar but with a significant increase in the LV S’ (4.77 vs. 6.01, p = 0.006). A longitudinal analysis at three time points showed a significant increase in RV FAC (0.02 units 95% CI (0.00–0.04), p = 0.037), TAPSE (0.09 units 95% CI (0.06–0.13), p < 0.001), RV S’ (0.97 units (95% CI = 0.11–1.84), p = 0.028), a reduction in the eccentricity index (0.07 units 95% CI (−0.14–−0.01), p = 0.030), and an increase in the LV S’ (0.56 units (95% CI = 0.18–0.94)). (4) Conclusion: The use of postnatal dexamethasone for the prevention/treatment of CLD in premature neonates resulted in an expected improvement in respiratory status along with a significant improvement in the echocardiographic measures of biventricular heart performance. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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21 pages, 2486 KiB

Open AccessArticle

Innovative Attention-Based Explainable Feature-Fusion VGG19 Network for Characterising Myocardial Perfusion Imaging SPECT Polar Maps in Patients with Suspected Coronary Artery Disease

by Ioannis D. Apostolopoulos, Nikolaοs D. Papathanasiou, Nikolaos Papandrianos, Elpiniki Papageorgiou and Dimitris J. Apostolopoulos

Appl. Sci. 2023, 13(15), 8839; https://doi.org/10.3390/app13158839 - 31 Jul 2023

Cited by 2 | Viewed by 1203

Abstract

Greece is among the European Union members topping the list of deaths related to coronary artery disease. Myocardial Perfusion Imaging (MPI) with Single-Photon Emission Computed Tomography (SPECT) is a non-invasive test used to detect abnormalities in CAD screening. The study proposes an explainable [...] Read more.

Greece is among the European Union members topping the list of deaths related to coronary artery disease. Myocardial Perfusion Imaging (MPI) with Single-Photon Emission Computed Tomography (SPECT) is a non-invasive test used to detect abnormalities in CAD screening. The study proposes an explainable deep learning (DL) method for characterising MPI SPECT Polar Map images in patients with suspected CAD. Patient data were recorded at the Department of Nuclear Medicine of the University Hospital of Patras from 16 February 2018 to 28 February 2022. The final study population included 486 patients. An attention-based feature-fusion network (AFF-VGG19) was proposed to perform the diagnosis, and the Grad-CAM++ algorithm was employed to reveal potentially significant regions. AFF-VGG19’s agreement with the medical experts was found to be 89.92%. When training and assessing using the ICA findings as a reference, AFF-VGG19 achieved good diagnostic strength (accuracy of 0.789) similar to that of the human expert (0.784) and with more balanced sensitivity and specificity rates (0.873 and 0.722, respectively) compared to the human expert (0.958 and 0.648, respectively). The visual inspection of the Grad-CAM++ regions showed that the model produced 77 meaningful explanations over the 100 selected samples, resulting in a slight accuracy decrease (0.77). In conclusion, this research introduced a novel and interpretable DL approach for characterising MPI SPECT Polar Map images in patients with suspected CAD. The high agreement with medical experts, robust diagnostic performance, and meaningful interpretability of the model support the notion that attention-based networks hold significant promise in CAD screening and may revolutionise medical decision-making in the near future. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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13 pages, 2690 KiB

Open AccessArticle

True Non-Contrast Phase versus Virtual-Non Contrast: “Lights and Shadows” of Dual Energy CT Angiography in Peripheral Arterial Disease

by Chiara Floridi, Laura Maria Cacioppa, Giacomo Agliata, Michaela Cellina, Nicolo’ Rossini, Tommaso Valeri, Martina Curzi, Alessandro Felicioli, Alessandra Bruno, Marzia Rosati, Roberto Candelari and Andrea Giovagnoni

Appl. Sci. 2023, 13(12), 7134; https://doi.org/10.3390/app13127134 - 14 Jun 2023

Cited by 1 | Viewed by 1136

Abstract

(1) Background: The value of dual-energy CT angiography (DE-CTA) in the detection of peripheral arterial disease (PAD) has been widely recognized. We aim to evaluate the diagnostic accuracy of virtual non-contrast (VNC) imaging of DE-CTA compared to true non-contrast phase (TNC). (2) Methods: [...] Read more.

(1) Background: The value of dual-energy CT angiography (DE-CTA) in the detection of peripheral arterial disease (PAD) has been widely recognized. We aim to evaluate the diagnostic accuracy of virtual non-contrast (VNC) imaging of DE-CTA compared to true non-contrast phase (TNC). (2) Methods: Our Internal Review Board (IRB) approved prospective study enrolled 40 patients (28 men, 12 women; median age 69 y, range 41–93 y) who underwent lower extremity DE-CTA for symptomatic PAD. Mean attenuation values of TNC and VNC were obtained by placing circular regions of interest (ROI) at five levels from the aortic to the popliteal arterial lumen, reported in Hounsfield units (HU), and compared using a two-sample t-test. The subjective quality of VNC images was assessed by two independent radiologists with 10 and 4 years of CTA-imaging experience according to a 4-point scale and verified by the intra-class correlation coefficient (ICC). Dose Length Product (DLP) values of each DE-CTA examination were also considered. (3) Results: Except for the external iliac artery, VNC attenuation values were significantly lower than the corresponding TNC values at all levels, with a mean difference ranging from 14.1 and 8.7 HU. At qualitative analysis, VNC images were considered excellent to diagnose in 40%, good in 50%, and sufficient in 10% of cases. No cases of non-diagnostic VNC imaging were reported. Avoiding the TNC phase, a mean reduction in DLP of 54% for each DE-CTA was estimated. (4) Conclusions: TNC and VNC images showed comparable reliability and diagnostic accuracy in the detection of PAD. VNC may be considered a promising substitute for TNC from the perspectives of dose reduction and workflow optimization. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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14 pages, 1896 KiB

Open AccessArticle

Aortic Hemodynamics with Accelerated Dual-Venc 4D Flow MRI in Type B Aortic Dissection

by Ozden Kilinc, Justin Baraboo, Joshua Engel, Daniel Giese, Ning Jin, Elizabeth K. Weiss, Anthony Maroun, Kelvin Chow, Xiaoming Bi, Rachel Davids, Christopher Mehta, S. Chris Malaisrie, Andrew Hoel, James Carr, Michael Markl and Bradley D. Allen

Appl. Sci. 2023, 13(10), 6202; https://doi.org/10.3390/app13106202 - 18 May 2023

Cited by 1 | Viewed by 1324

Abstract

The aim of this study is to investigate the applicability of the dual-venc (DV) 4D flow magnetic resonance imaging (MRI) to quantify the complex flow patterns in type B aortic dissection (TBAD). One GRAPPA-accelerated single-venc (SV) and one compressed-sensing (CS) accelerated DV 4D [...] Read more.

The aim of this study is to investigate the applicability of the dual-venc (DV) 4D flow magnetic resonance imaging (MRI) to quantify the complex flow patterns in type B aortic dissection (TBAD). One GRAPPA-accelerated single-venc (SV) and one compressed-sensing (CS) accelerated DV 4D flow MRI sequences are used to scan all subjects, including twelve chronic TBAD patients and two volunteers. The scans are performed twice for the reproducibility assessment of the scan protocols. Voxelwise quantitative flow parameters including kinetic energy (KE), peak velocity (PV), forward and reverse flows (FF, RF) and stasis are calculated. High-venc (HV) data from the DV acquisition are separately analyzed. The scan time reduction by the CS-accelerated DV 4D flow MRI acquisition is 46.4% compared with the SV acquisition. The DV velocity-to-noise ratio (VNR) is higher compared with HV (p = 0.000). No true lumen (TL) parameter shows a significant difference among the acquisition types (p > 0.05). The false lumen (FL) RF is higher in SV compared with the DV acquisition (p = 0.009). The KE is higher (p = 0.038) and stasis is lower (p = 0.01) in HV compared with SV acquisition. All FL parameters except stasis are higher and stasis is lower in HV compared with DV acquisition (p < 0.05). Positive Pearson correlations among the acquisition types in TL and high agreements between the two scans for all acquisition types are observed except HV RF in the FL, which demonstrates a moderate agreement. The CS-accelerated DV 4D flow MRI may have utility in the clinical daily routine with shortened scan times and improved velocity measurements while providing high VNR in TBAD. The observed hemodynamic flow trends are similar between GRAPPA-accelerated SV and CS-accelerated DV 4D flow MRI acquisitions; however, parameters are more impacted by CS-accelerated HV protocol in FL, which may be secondary to the CS regularization effects. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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12 pages, 913 KiB

Open AccessArticle

Handling Extensive Mitral Annular Calcification via a Minimally Invasive Right Mini-Thoracotomy Approach

by Cristina Barbero, Antonio Spitaleri, Marco Pocar, Barbara Parrella, Ambra Santonocito, Elena Bozzo, Alessandro Depaoli, Riccardo Faletti and Mauro Rinaldi

Appl. Sci. 2023, 13(4), 2563; https://doi.org/10.3390/app13042563 - 16 Feb 2023

Cited by 1 | Viewed by 1702

Abstract

Mitral annular calcification is a chronic and degenerative process of the fibrous base of the mitral valve. Surgical management of mitral valve dysfunction with severe annular calcification remains technically demanding and, to date, the preferred approach is still a standard full sternotomy. We [...] Read more.

Mitral annular calcification is a chronic and degenerative process of the fibrous base of the mitral valve. Surgical management of mitral valve dysfunction with severe annular calcification remains technically demanding and, to date, the preferred approach is still a standard full sternotomy. We aimed to analyze and report our experience with mitral valve surgery addressing annular calcification via the minimally invasive approach through a right mini-thoracotomy. Data of patients with mitral valve disease and underlying annular calcification undergoing minimally invasive surgery from 2018 to 2022 were prospectively collected and retrospectively analyzed. The severity of mitral annular calcification was categorized with an angio-computerized tomography scan analysis as mild, moderate or severe according to calcium thickness, calcium distribution, and trigone and leaflet involvement using the Mitral Annular Calcification Computerized Tomography-score. During the study period, 27 patients with mitral valve disease and associated mitral annular calcification were enrolled. The most common etiology was advanced Barlow’s disease, which was encountered in 18 cases (67%). Mitral valve replacement was performed in 21 patients (78%). No intraoperative death, atrioventricular disruption, or circumflex coronary artery injury occurred. Conversion to sternotomy was necessary in a single case. Residual moderate periprosthetic leak requiring early reoperation and permanent heart block mandating permanent pacemaker implantation were reported in one and in three patients, respectively. No cases of stroke were reported. Two patients died, accounting for a 7.4% perioperative mortality. At a median follow-up of 9 months, one patient had residual moderate mitral regurgitation, whereas two patients required short-term reoperation and prosthetic valve (re)replacement. Minimally invasive mitral valve surgery via right mini-thoracotomy should be considered an and effective approach to be indicated also in patients with mild-to-severe mitral annular calcification. Routine angio-computerized tomography scan during work-up is a mandatory step to stratify the anatomical extension and severity of the mitral annular calcification. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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17 pages, 4382 KiB

Open AccessArticle

Straightened Segmentation in 4D Cardiac CT: A Practical Method for Multiparametric Characterization of the Landing Zone for Transcatheter Pulmonary Valve Replacement

by Xiaolin Sun, Yimeng Hao, Marvin Steitz, Alexander Breitenstein-Attach, Jonathan Frederik Sebastian Kiekenap, Jasper Emeis, Mahamuda Badhon Khan, Felix Berger and Boris Schmitt

Appl. Sci. 2022, 12(24), 12912; https://doi.org/10.3390/app122412912 - 15 Dec 2022

Viewed by 1425

Abstract

Cardiac computed tomography angiography (C-CTA) is crucial in assessing the right ventricular outflow tract (RVOT) prior to a transcatheter pulmonary valve replacement (TPVR), as an incorrect evaluation can make the procedure more challenging and can lead to device-related complications. This study aimed to [...] Read more.

Cardiac computed tomography angiography (C-CTA) is crucial in assessing the right ventricular outflow tract (RVOT) prior to a transcatheter pulmonary valve replacement (TPVR), as an incorrect evaluation can make the procedure more challenging and can lead to device-related complications. This study aimed to evaluate the feasibility and accuracy of 4D straightened segmentation for a landing zone analysis over anatomical segmentation. Seven pre-operative CTAs and seven post-operative CTAs were used to measure the cross-sectional area, circumference, and diameters at five selected planes as the landing zone for TPVR and compared these to the 4D straightened model with the anatomical model. Furthermore, the right ventricular volume, stent volume, and 4D ellipticity index were calculated from the 4D straightened model. The 4D straightened segmentation had comparable accuracy and efficacy for the measurements at the landing zone. The cross-sectional area and the circumference varied greatly at the RVOT and the basal plane of the pulmonary valve compared with the other three planes of the 4D straightened models from the pre-operative CTAs; however, only the values at the RVOT were found to vary greatly from the post-operative CTAs. The 4D straightened model can provide accurate measurements and is thus a useful method for the periprocedural evaluation of TPVR. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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13 pages, 1710 KiB

Open AccessArticle

Whole-Heart Assessment of Turbulent Kinetic Energy in the Repaired Tetralogy of Fallot

by Ashifa Hudani, James A. White, Steven C. Greenway and Julio Garcia

Appl. Sci. 2022, 12(21), 10946; https://doi.org/10.3390/app122110946 - 28 Oct 2022

Cited by 3 | Viewed by 1615

Abstract

Approximately 10% of congenital heart diseases (CHDs) include Tetralogy of Fallot (TOF). Fortunately, due to advanced surgical techniques, most patients survive until adulthood. However, these patients require frequent monitoring for postoperative complications leading to heart hemodynamic alterations. Turbulent kinetic energy (TKE), as derived [...] Read more.

Approximately 10% of congenital heart diseases (CHDs) include Tetralogy of Fallot (TOF). Fortunately, due to advanced surgical techniques, most patients survive until adulthood. However, these patients require frequent monitoring for postoperative complications leading to heart hemodynamic alterations. Turbulent kinetic energy (TKE), as derived from 4D-flow magnetic resonance imaging (4D-flow MRI), has been used to characterize abnormal heart hemodynamics in CHD. Hence, this study aimed to assess the difference in TKE between patients with repaired TOF (rTOF) and healthy volunteers. A total of 35 subjects, 17 rTOF patients and 18 controls, underwent standard-of-care cardiac MRI and research 4D-flow MRI using a clinical 3T scanner. Heart chambers and great vessels were segmented using 3D angiograms derived from 4D-flow MRI. The TKE was quantified within segmented volumes. TKE was compared to standard cardiac MRI metrics. Controls demonstrated higher TKE in the left atria and left ventricle. However, patients demonstrated higher TKE in the right atria, right ventricle (p < 0.05), and pulmonary artery. Lastly, no correlation was observed between TKE and standard clinical measurements. TKE can be a key indicator of the abnormal hemodynamics present in patients with rTOF and can assist future interventions and help monitor long-term outcomes. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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13 pages, 2650 KiB

Open AccessArticle

Single Puncture TIPS—A 3D Fusion Image-Guided Transjugular Intrahepatic Portosystemic Shunt (TIPS): An Experimental Study

by Edward Wolfgang Lee, Puja Shahrouki, Sammy Saab, Fady Kaldas, Navid Eghbalieh, Justin McWilliams, Peng-Xu Ding and Stephen T. Kee

Appl. Sci. 2022, 12(10), 5267; https://doi.org/10.3390/app12105267 - 23 May 2022

Cited by 1 | Viewed by 1821

Abstract

Background: The use of a transjugular intrahepatic portosystemic shunt (TIPS) has been established as an effective treatment for portal hypertension. Despite the rapid development of this use, serious peri-procedural complications have been reported in over 10% of cases. This has largely been attributed [...] Read more.

Background: The use of a transjugular intrahepatic portosystemic shunt (TIPS) has been established as an effective treatment for portal hypertension. Despite the rapid development of this use, serious peri-procedural complications have been reported in over 10% of cases. This has largely been attributed to the access to the portal vein, also referred to as a “blind puncture”, which often requires multiple attempts. The aim of this study was to demonstrate the safety, reproducibility and accuracy of the use of real-time 3D fusion image-guided (3DFIG) single puncture TIPS to minimize the complications that are related to the “blind puncture” of TIPS procedures. Methods: A 3DFIG TIPS approach was utilized on 22 pigs by combining pre-procedural cross-sectional imaging (CT, MR or CBCT) with intra-procedural cone beam CT or angiogram imaging, which allowed for the improved 3D visual spatial orientation of the portal vein and real-time tracking of the needle in 3D. Results: Thirty-five portosystemic shunts were successfully deployed in all 22 subjects without any peri-procedural complications. Overall, 91% (32/35) of the procedures were carried out using a single puncture. In addition, the mean fluoroscopy time in our study was more than 12 times lower than the proposed reference level that has previously been proposed for TIPS procedures. Conclusion: Multi-modality real-time 3DFIG TIPS can be performed safely using a single puncture, without complications, and can potentially be used in both emergency and non-emergency clinical situations. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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8 pages, 881 KiB

Open AccessArticle

A Multicenter, Retrospective, Matched, Comparison Study of Clinical Efficacy and Cost-Effectiveness of Caterpillar Arterial Embolization Device versus Fibered Coils in Arterial Embolization

by Megan J. Sue, Thanh T. Luong, Jonathan Park, Peng-Xu Ding, Frank Hao, Navid Eghbalieh and Edward Wolfgang Lee

Appl. Sci. 2022, 12(10), 5262; https://doi.org/10.3390/app12105262 - 23 May 2022

Cited by 1 | Viewed by 1548

Abstract

Background: The purpose of this study was to evaluate and compare the clinical effectiveness and costs of using the Caterpillar Arterial Embolization Device (Caterpillar) and fibered coils in arterial embolization cases. Methods: In this multicenter retrospective study, demographic, laboratory, and procedural data were [...] Read more.

Background: The purpose of this study was to evaluate and compare the clinical effectiveness and costs of using the Caterpillar Arterial Embolization Device (Caterpillar) and fibered coils in arterial embolization cases. Methods: In this multicenter retrospective study, demographic, laboratory, and procedural data were collected on a total of 48 patients between February 2020 and September 2020. Data were collected on 16 Caterpillar placements and matched with 32 controls who underwent coil embolization of the same vessel with a similar size. Clinical and procedural outcomes including type and size of vessels, time to vessel occlusion, fluoroscopy time, total procedure time, and costs were analyzed and compared. Results: Relative time to occlusion was significantly decreased in the Caterpillar group compared to the controls (57 ± 34 s vs. 11 min 44 s ± 8 min 13 s, p = 0.00001611). Fluoroscopy time (6.9 ± 15 min vs. 19.2 ± 14, p = 0.017) and total procedure time (81.0 ± 36 min vs. 111.5 ± 49 min, p = 0.015) were significantly reduced compared to the coil group. Lastly, overall cost of embolic materials was 1050 ± 0 USD for the Caterpillar group compared to 2312.75 ± 1382.84 USD in the coil group (p = 0.000532). Conclusion: The Caterpillar embolic devices appear safe and effective in arterial occlusion. Compared to fibered coils, the Caterpillar device results in decreased time to vessel occlusion, decreased fluoroscopy and procedural time, and decreased costs, making the Caterpillar an appealing choice for arterial embolization. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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Review

Jump to: Editorial, Research

15 pages, 1341 KiB

Open AccessReview

Cardiac Nuclear Imaging Findings in Atypical Variants of Takotsubo Cardiomyopathy

by Maria Silvia De Feo, Miriam Conte, Viviana Frantellizzi, Luca Filippi, Laura Evangelista, Maria Ricci and Giuseppe De Vincentis

Appl. Sci. 2024, 14(2), 487; https://doi.org/10.3390/app14020487 - 5 Jan 2024

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Abstract

Background: In addition to the typical form resembling the classical Japanese octopus trap, atypical variants of Takotsubo cardiomyopathy (TTC) sparing the left ventricular apex have emerged over the years. The aim of this systematic review is to provide a comprehensive overview of the [...] Read more.

Background: In addition to the typical form resembling the classical Japanese octopus trap, atypical variants of Takotsubo cardiomyopathy (TTC) sparing the left ventricular apex have emerged over the years. The aim of this systematic review is to provide a comprehensive overview of the cardiac nuclear imaging findings in atypical variants. Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The literature research was carried out online on the Pubmed, Scopus, Central (Cochrane Library), and Web Of Science databases. Results: A total of 14 articles were ultimately selected. Myocardial perfusion scintigraphy was performed in nine studies, followed by 123I-mIBG scintigraphy, 123I-BMIPP scintigraphy, and 18F-FDG PET. In seven cases, a single cardiac nuclear imaging technique was performed, while in the remaining five and two cases, two and three different imaging modalities were, respectively, used. The most common atypical variant of our selection was the midventricular form, followed by reverse/inverted/basal TTC, with only a single case reported of a focal pattern. Conclusions: As the reason why TTC variants occur is still not clear, a deeper understanding of the current knowledge could be the basis for providing more insights into this fascinating disorder and its uncommon manifestations. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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15 pages, 828 KiB

Open AccessReview

Assessment of Cardiovascular Disease in Autosomal Dominant Polycystic Kidney Disease

by Antonietta Gigante, Adolfo Marco Perrotta, Francesca Tinti, Eleonora Assanto, Maurizio Muscaritoli, Silvia Lai and Rosario Cianci

Appl. Sci. 2023, 13(12), 7175; https://doi.org/10.3390/app13127175 - 15 Jun 2023

Cited by 2 | Viewed by 1076

Abstract

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited kidney disease which leads to progressive kidney failure. About 5–10% of patients requiring renal replacement therapy are affected by ADPKD. Cardiovascular diseases are the main causes of morbidity and mortality in these patients with [...] Read more.

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited kidney disease which leads to progressive kidney failure. About 5–10% of patients requiring renal replacement therapy are affected by ADPKD. Cardiovascular diseases are the main causes of morbidity and mortality in these patients with ADPKD; arterial hypertension (AH) is the first symptom with a very early onset. Anyway, some other cardiovascular abnormalities have been reported in ADPKD regardless of the presence of AH. With this background, we conducted a systematic review, collecting all randomized controlled trials (RCTs) and quasi-RCTs found on the main databases; we evaluated the evidence about different imaging techniques to grade the cardiovascular risk in a very early stage of disease. This review aims to describe all cardiovascular assessments in ADPKD patients to improve clinicians’ ability to discover cardiovascular involvement early, allowing appropriate therapies promptly. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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31 pages, 15451 KiB

Open AccessReview

Translational Echocardiography: The Dog as a Clinical Research Model of Cardiac Dysfunction

by Cesar Augusto Flores Dueñas, Ignacio Alonso Cordero Yañez, Roberto Mujica González, José Carlomán Herrera Ramírez, Martín Francisco Montaño Gómez, Soila Maribel Gaxiola Camacho and Issa Carolina García Reynoso

Appl. Sci. 2023, 13(7), 4437; https://doi.org/10.3390/app13074437 - 31 Mar 2023

Viewed by 3038

Abstract

Heart disease is a major contributor to mortality and disability on a global scale. Hence, there is a need for research to improve non-invasive diagnostic techniques. Diseases in dogs with characteristics very similar to those of human pathologies hold promise as a source [...] Read more.

Heart disease is a major contributor to mortality and disability on a global scale. Hence, there is a need for research to improve non-invasive diagnostic techniques. Diseases in dogs with characteristics very similar to those of human pathologies hold promise as a source of data for evaluating and developing echocardiographic techniques and devices. Methods: We conducted a structured literature search from June 2022 to January 2023 to evaluate the relevance of dogs as a translational model for echocardiographic clinical research. We searched various academic databases, including PubMed Central (PMC), Core, DIGITAL.CSIC, DOAB, DOAJ, EBSCO host, Elsevier B.V, Redib, Scopus, and Web of Science, available through the Academic Information System of the Autonomous University of Baja California. Results: Out of the 243 articles initially screened, we identified 119 relevant articles that met our inclusion criteria for further analysis. This review is an introduction to the canine model by analyzing the cardiovascular anatomical similarities between the two species, the pathophysiological overlaps in some diseases, the parallels in echocardiographic techniques in dogs compared to humans, and the suitability of dogs with a naturally occurring cardiac disease as a model for translational clinical research compared to other animal species. Conclusions: This review emphasizes the importance of canine patients as an ideal cardiac disease symmetrical clinical model since they share common heart diseases with humans. Furthermore, dogs have a shorter lifespan, leading to the relatively rapid evolution of these diseases, which makes studying these pathologies and developing echocardiographic techniques more feasible. The results strongly indicate the need for interdisciplinary collaboration and translational medical research to create innovative echocardiographic technologies and improve the connection between veterinary and human cardiac imaging research. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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14 pages, 2158 KiB

Open AccessReview

Impact of LGE-MRI in Arrhythmia Ablation

by Paz Garre, Sara Vázquez-Calvo, Elisenda Ferro, Till Althoff and Ivo Roca-Luque

Appl. Sci. 2023, 13(6), 3862; https://doi.org/10.3390/app13063862 - 17 Mar 2023

Viewed by 1897

Abstract

The use of late gadolinium enhancement magnetic resonance imaging (LGE-MRI) in arrhythmia ablation is increasing due to the capacity to detect, quantify and characterize cardiac fibrosis both in atrium and ventricle. Catheter ablation has become a standard treatment for arrhythmias, and LGE-MRI has [...] Read more.

The use of late gadolinium enhancement magnetic resonance imaging (LGE-MRI) in arrhythmia ablation is increasing due to the capacity to detect, quantify and characterize cardiac fibrosis both in atrium and ventricle. Catheter ablation has become a standard treatment for arrhythmias, and LGE-MRI has demonstrated to be a useful tool to plan and guide ablation. Furthermore, recent studies have proved the usefulness in substrate analysis and postablation evaluation. This review will analyze the application and the current role of LGE-MRI to improve strategies for the two main cardiac arrhythmias: Atrial fibrillation and ventricular tachycardia. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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26 pages, 55629 KiB

Open AccessReview

Designing the Optimal Procedure: Role of CT Scan in the Planning of Transcatheter Structural Heart Interventions

by Simone Circhetta, Edoardo Nobile, Aurelio De Filippis, Luisa Vicchio, Annunziata Nusca, Domenico De Stefano, Francesco Piccirillo, Valeria Cammalleri, Fabio Mangiacapra, Elisabetta Ricottini, Rosetta Melfi, Raffaele Rinaldi, Carlo Cosimo Quattrocchi, Francesco Grigioni and Gian Paolo Ussia

Appl. Sci. 2023, 13(3), 1589; https://doi.org/10.3390/app13031589 - 26 Jan 2023

Cited by 1 | Viewed by 4049

Abstract

Computed tomography (CT) scanning has recently assumed a first-pillar role in the preoperative planning of patients undergoing transcatheter structural heart procedures (e.g., transcatheter aortic valve implantation, TAVI; MitraClip; Triclip; left atrial appendage occlusion, LAAO). A careful preprocedural assessment is crucial for achieving the [...] Read more.

Computed tomography (CT) scanning has recently assumed a first-pillar role in the preoperative planning of patients undergoing transcatheter structural heart procedures (e.g., transcatheter aortic valve implantation, TAVI; MitraClip; Triclip; left atrial appendage occlusion, LAAO). A careful preprocedural assessment is crucial for achieving the best possible result, and, currently, CT represents the paramount technique to obtain morphological data on cardiac and vessel structures, thus allowing to choose the most appropriate vascular approach, the type and size of devices, and all the required steps to meet procedural expectations. The image reconstruction accuracy also provides information to predict potential complications such as misplacements and leakages. This review aims to describe the role of CT in the decision-making approach of patients undergoing structural heart interventions and expand the clinicians’ understanding of the benefits and drawbacks of this imaging technique. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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25 pages, 3716 KiB

Open AccessReview

Beyond the Calcium Score: What Additional Information from a CT Scan Can Assist in Cardiovascular Risk Assessment?

by Federico Bernardini, Martina Gelfusa, Mihail Celeski, Federica Coletti, Annunziata Nusca, Domenico De Stefano, Francesco Piccirillo, Fabio Mangiacapra, Paolo Gallo, Valeria Cammalleri, Nino Cocco, Raffaele Rinaldi, Carlo Cosimo Quattrocchi, Gian Paolo Ussia and Francesco Grigioni

Appl. Sci. 2023, 13(1), 241; https://doi.org/10.3390/app13010241 - 25 Dec 2022

Cited by 2 | Viewed by 6777

Abstract

Coronary artery disease (CAD) still represents a leading cause of mortality worldwide. Early identification of patients at the highest risk of CAD is crucial to prevent acute adverse events and reduce morbidity and mortality. The coronary artery calcium (CAC) score is a reliable [...] Read more.

Coronary artery disease (CAD) still represents a leading cause of mortality worldwide. Early identification of patients at the highest risk of CAD is crucial to prevent acute adverse events and reduce morbidity and mortality. The coronary artery calcium (CAC) score is a reliable cardiovascular (CV) risk index with an independent prognostic value. Guidelines recommend using it as a risk enhancer in individuals with low or moderate CV risk. However, other computed tomography (CT) measurable parameters have recently been proposed as CV risk markers. Increasing evidence demonstrates the association between epicardial fat volume and coronary atherosclerosis in chronic and acute coronary syndromes. Furthermore, other parameters obtainable from CT, such as aortic stiffness, liver fat, aortic calcium, and myocardial scarring, are under investigation. This review aims to describe all CT potential in atherosclerosis detection and cardiovascular risk assessment beyond the CAC, trying to understand how to integrate CT parameters with traditional risk factors and to improve clinicians' ability to detect CAD early, allowing appropriate therapies promptly. Full article

(This article belongs to the Special Issue Biomedical Imaging Technologies for Cardiovascular Disease - Volume II)

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