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Turkish Journal of Medical Sciences 2024The aim of this study is to evaluate the baseline F18-FDG PET/CT findings of individuals diagnosed with giant cell arteritis (GCA) and to explore its association with...
BACKGROUND/AIM
The aim of this study is to evaluate the baseline F18-FDG PET/CT findings of individuals diagnosed with giant cell arteritis (GCA) and to explore its association with clinical findings and classification criteria.
MATERIALS AND METHODS
We analysed data from patients who underwent F18-FDG PET/CT scans to investigate large vessel (LV) involvement between 2010 and 2019. Only patients with a clinical diagnosis of GCA and at least 6 months of follow-up were included. We compared initial clinical features and laboratory findings based on the presence of LV vasculitis on PET/CT and the maximum standard uptake value (SUVmax) of vascular territories.
RESULTS
Twenty-nine patients (median age at diagnosis: 70, F/M: 24/5) were included in the study. Among them, 21 patients (72.4%) presented with cranial symptoms, while 8 patients (27.5%) had isolated LV-GCA. Twenty-two patients (75.9%) met the ACR/EULAR 2022 GCA classification criteria. LV vasculitis was detected on PET/CT in 23 patients (79.3%). A positive correlation was observed between SUVmax in the thoracic aorta and both CRP and ESR levels (r = 0.50, p = 0.026 and r = 0.63, p = 0.002, respectively). PET/CT positive patients were found to be younger (p = 0.016) and more frequently female (p = 0.017). They also exhibited fewer headaches (56.5% vs. 100%, p = 0.04), experienced fewer flares during follow-up (p = 0.03), and had a lower cumulative glucocorticoid dose at the 6th month (p = 0.036). Comparison of PET/CT-positive patients (n = 23) based on the fulfilment of the ACR/EULAR 2022 classification criteria revealed that patients who met these criteria were older (p = 0.02) and had significantly lower CRP levels at diagnosis (p = 0.02).
CONCLUSION
The performance of F18-FDG PET/CT in diagnosing LV involvement in GCA is favourable, and the severity of FDG uptake in the vessel wall correlates with the acute phase response. Patients with extracranial involvement on PET/CT exhibit distinct features, including a younger age and female predominance. Additionally, these patients appear to experience fewer relapses and require lower doses of glucocorticoids. However, the clinical significance of PET/CT in patients who met ACR/EULAR classification criteria, predominantly consisting of patients with ischemic cranial symptoms, could not be determined in our study.
Topics: Humans; Giant Cell Arteritis; Female; Fluorodeoxyglucose F18; Male; Aged; Positron Emission Tomography Computed Tomography; Middle Aged; Radiopharmaceuticals; Aged, 80 and over; Retrospective Studies
PubMed: 38812633
DOI: 10.55730/1300-0144.5767 -
Radiology Case Reports Aug 2024Double aortic arch (DAA) is a rare congenital abnormality characterized by a vascular ring that often requires surgical intervention due to respiratory complications....
Double aortic arch (DAA) is a rare congenital abnormality characterized by a vascular ring that often requires surgical intervention due to respiratory complications. The DAA and right aortic arch with mirror-image branches (RAA-MB) represent abnormalities in development of the aortic arch. However, prognosis differs significantly, as the DAA forms vascular rings, whereas the RAA-MB typically does not. Distinguishing between the conditions becomes particularly challenging in cases of DAA with closure of the posterior portion of the left aortic arch (LAA) because the postnatal manifestations closely resemble those of RAA-MB. Herein, we present a case of DAA in which longitudinal observation of the LAA and RAA diameters during pregnancy aimed in predicting postnatal closure of the LAA. A 37-year-old female with suspected DAA was referred to our hospital at 26 weeks of gestation. Initial measurements revealed comparable diameters for the LAA and RAA; however, the LAA diameter decreased to approximately half that of the RAA by term owing to growth restrictions. Postnatal contrast computed tomography confirmed the closure of the posterior portion of the LAA and RAA with Kommerell diverticulum. Our findings suggest that careful monitoring of DAA throughout fetal development, especially during the third trimester, may aid in predicting atretic changes in the nondominant arch after birth, allowing an easy distinction between the DAA and RAA-MB after birth.
PubMed: 38812596
DOI: 10.1016/j.radcr.2024.04.060 -
Journal of Cardiothoracic Surgery May 2024To assess whether retrograde cerebral perfusion reduces neurological injury and mortality in patients undergoing surgery for acute type A aortic dissection. (Observational Study)
Observational Study
BACKGROUND
To assess whether retrograde cerebral perfusion reduces neurological injury and mortality in patients undergoing surgery for acute type A aortic dissection.
METHODS
Single-center, retrospective, observational study including all patients undergoing acute type A aortic dissection repair with deep hypothermic circulatory arrest between January 1998 and December 2022 with or without the adjunct of retrograde cerebral perfusion. 515 patients were included: 257 patients with hypothermic circulatory arrest only and 258 patients with hypothermic circulatory arrest and retrograde cerebral perfusion. The primary endpoints were clinical neurological injury, embolic lesions, and watershed lesions. Multivariable logistic regression was performed to identify independent predictors of the primary outcomes. Survival analysis was performed using Kaplan-Meier estimates.
RESULTS
Clinical neurological injury and embolic lesions were less frequent in patients with retrograde cerebral perfusion (20.2% vs. 28.4%, p = 0.041 and 13.7% vs. 23.4%, p = 0.010, respectively), but there was no significant difference in the occurrence of watershed lesions (3.0% vs. 6.1%, p = 0.156). However, after multivariable logistic regression, retrograde cerebral perfusion was associated with a significant reduction of clinical neurological injury (OR: 0.60; 95% CI 0.36-0.995, p = 0.049), embolic lesions (OR: 0.55; 95% CI 0.31-0.97, p = 0.041), and watershed lesions (OR: 0.25; 95%CI 0.07-0.80, p = 0.027). There was no significant difference in 30-day mortality (12.8% vs. 11.7%, p = ns) or long-term survival between groups.
CONCLUSION
In this study, we showed that the addition of retrograde cerebral perfusion during hypothermic circulatory arrest in the setting of acute type A aortic dissection repair reduced the risk of clinical neurological injury, embolic lesions, and watershed lesions.
Topics: Humans; Aortic Dissection; Female; Male; Circulatory Arrest, Deep Hypothermia Induced; Retrospective Studies; Middle Aged; Perfusion; Cerebrovascular Circulation; Aged; Postoperative Complications; Aortic Aneurysm, Thoracic
PubMed: 38811972
DOI: 10.1186/s13019-024-02814-8 -
Scientific Reports May 2024Atherosclerosis is the build-up of fatty plaques within blood vessel walls, which can occlude the vessels and cause strokes or heart attacks. It gives rise to both...
Atherosclerosis is the build-up of fatty plaques within blood vessel walls, which can occlude the vessels and cause strokes or heart attacks. It gives rise to both structural and biomolecular changes in the vessel walls. Current single-modality imaging techniques each measure one of these two aspects but fail to provide insight into the combined changes. To address this, our team has developed a dual-modality imaging system which combines optical coherence tomography (OCT) and fluorescence imaging that is optimized for a porphyrin lipid nanoparticle that emits fluorescence and targets atherosclerotic plaques. Atherosclerosis-prone apolipoprotein (Apo)e mice were fed a high cholesterol diet to promote plaque development in descending thoracic aortas. Following infusion of porphyrin lipid nanoparticles in atherosclerotic mice, the fiber-optic probe was inserted into the aorta for imaging, and we were able to robustly detect a porphyrin lipid-specific fluorescence signal that was not present in saline-infused control mice. We observed that the nanoparticle fluorescence colocalized in areas of CD68 macrophages. These results demonstrate that our system can detect the fluorescence from nanoparticles, providing complementary biological information to the structural information obtained from simultaneously acquired OCT.
Topics: Tomography, Optical Coherence; Animals; Plaque, Atherosclerotic; Nanoparticles; Mice; Porphyrins; Optical Imaging; Disease Models, Animal; Atherosclerosis; Macrophages; Lipoproteins, HDL
PubMed: 38811670
DOI: 10.1038/s41598-024-63132-6 -
Journal of Cardiovascular Magnetic... May 2024Three-dimensional (3D) contrast-enhanced MR angiography (CEMRA) is routinely used for vascular evaluation. With existing techniques for CEMRA, diagnostic image quality...
BACKGROUND
Three-dimensional (3D) contrast-enhanced MR angiography (CEMRA) is routinely used for vascular evaluation. With existing techniques for CEMRA, diagnostic image quality is only obtained during the first pass of the contrast agent or shortly thereafter, whereas angiographic quality tends to be poor when imaging is delayed to the equilibrium phase. We hypothesized that prolonged blood pool contrast enhancement could be obtained by imaging with a balanced T1 relaxation-enhanced steady-state (bT1RESS) pulse sequence, which combines 3D balanced steady-state free precession (bSSFP) with a saturation recovery magnetization preparation to impart T1 weighting and suppress background tissues. An electrocardiographic (ECG)-gated, 2D-accelerated version with isotropic 1.1-mm spatial resolution was evaluated for breath-hold equilibrium phase CEMRA of the thoracic aorta and heart. Main body The study was IRB approved. 21 subjects were imaged using unenhanced 3D bSSFP, time-resolved CEMRA, first pass gated CEMRA, followed by early and late equilibrium phase gated CEMRA and bT1RESS. 9 additional subjects were imaged using equilibrium phase 3D bSSFP and bT1RESS. Images were evaluated for image quality, aortic root sharpness, and visualization of the coronary artery origins, as well as using standard quantitative measures.
RESULTS
Equilibrium phase bT1RESS provided better image quality, aortic root sharpness, and coronary artery origin visualization than gated CEMRA (P<0.05), and improved image quality and aortic root sharpness versus unenhanced 3D bSSFP (P<0.05). It provided significantly larger apparent signal-to-noise and apparent contrast-to-noise ratio values than gated CEMRA and unenhanced 3D bSSFP (P<0.05) and provided ninefold better fluid suppression than equilibrium phase 3D bSSFP. Aortic diameter and main pulmonary artery diameter measurements obtained with bT1RESS and first pass gated CEMRA strongly correlated (P<0.05).
DISCUSSION AND CONCLUSION
We found that using bT1RESS greatly prolongs the useful duration of blood pool contrast enhancement while improving angiographic image quality compared with standard CEMRA techniques. Although further study is needed, potential advantages for vascular imaging include eliminating the current requirement for first pass imaging along with better reliability and accuracy for a wide range of cardiovascular applications.
PubMed: 38810732
DOI: 10.1016/j.jocmr.2024.101046 -
European Heart Journal. Case Reports May 2024
Branch retinal artery occlusion with non-obstructive general angioscopy confirmed puff-chandelier rupture releasing cholesterol crystals in the aortic arch: a case report.
PubMed: 38807941
DOI: 10.1093/ehjcr/ytae238 -
Open Heart May 2024This study aims to compare aortic morphology between repaired coarctation patients and controls, and to identify aortic morphological risk factors for hypertension and...
OBJECTIVE
This study aims to compare aortic morphology between repaired coarctation patients and controls, and to identify aortic morphological risk factors for hypertension and cardiovascular events (CVEs) in coarctation patients.
METHODS
Repaired coarctation patients with computed tomography angiography (CTA) or magnetic resonance angiography (MRA) were included, followed-up and compared with sex-matched and age-matched controls. Three-dimensional aortic shape was reconstructed using patients' CTA or MRA, or four-dimensional flow cardiovascular magnetic resonance in controls, and advanced geometrical characteristics were calculated and visualised using statistical shape modelling. In patients, we examined the association of geometrical characteristics with (1) baseline hypertension, using multivariable logistic regression; and (2) cardiovascular events (CVE, composite of aortic complications, coronary artery disease, ventricular arrhythmias, heart failure hospitalisation, stroke, transient ischaemic attacks and cardiovascular death), using multivariable Cox regression. The least absolute shrinkage and selection operator (LASSO) method selected the most informative multivariable model.
RESULTS
Sixty-five repaired coarctation patients (23 years (IQR 19-38)) were included, of which 44 (68%) patients were hypertensive at baseline. After a median follow-up of 8.7 years (IQR 4.8-15.4), 27 CVEs occurred in 20 patients. Aortic arch dimensions were smaller in patients compared with controls (diameter p<0.001, wall surface area p=0.026, volume p=0.007). Patients had more aortic arch torsion (p<0.001) and a higher curvature (p<0.001). No geometrical characteristics were associated with hypertension. LASSO selected left ventricular mass, male sex, tortuosity and age for the multivariable model. Left ventricular mass (p=0.014) was independently associated with CVE, and aortic tortuosity showed a trend towards significance (p=0.070).
CONCLUSION
Repaired coarctation patients have a smaller aortic arch and a more tortuous course of the aorta compared with controls. Besides left ventricular mass index, geometrical features might be of importance in long-term risk assessment in coarctation patients.
Topics: Humans; Aortic Coarctation; Male; Female; Computed Tomography Angiography; Adult; Risk Factors; Young Adult; Magnetic Resonance Angiography; Follow-Up Studies; Time Factors; Aorta, Thoracic; Retrospective Studies; Magnetic Resonance Imaging, Cine; Risk Assessment; Treatment Outcome; Hypertension; Adolescent
PubMed: 38806222
DOI: 10.1136/openhrt-2024-002642 -
Frontiers in Genetics 2024Congenital heart disease (CHD) is the most common congenital anomaly. Up to 33% have an identifiable genetic etiology. Improved medical and surgical management of CHD...
BACKGROUND
Congenital heart disease (CHD) is the most common congenital anomaly. Up to 33% have an identifiable genetic etiology. Improved medical and surgical management of CHD has translated into longer life expectancy and a rapidly growing population of adults living with CHD. The adult CHD (ACHD) population did not have access during childhood to the genetic technologies available today and therefore have not had a robust genetic evaluation that is currently recommended for infants with CHD. Given this potential benefit; the aims of this study were to determine how ACHD cardiologists offer genetics services to patients and identify the indications that influence decision-making for genetics care.
METHODS
We performed a descriptive cross-sectional study of ACHD cardiologists. A study-developed questionnaire was distributed via emailed REDCap link. The recruitment email was sent to 104 potential respondents. The survey was open from 06/2022 to 01/2023.
RESULTS
Thirty-five cardiologists participated in the study (response rate of 34%). Most cardiologists identified as white (77%) and male (66%). Cardiologists were more likely to refer patients to genetics (91%) than to order testing themselves (57%). Of the testing ordered, chromosomal testing (55%) was ordered more than gene sequencing (14%). Most cardiologists would refer a patient with a conotruncal lesion (interrupted aortic arch) over other indications for a genetics evaluation. There were more reported barriers to ordering genetic testing (66%) compared to referring to genetics for a genetics evaluation (23%). Cardiologists were more confident recognizing features suggestive of a genetic syndrome than ordering the correct test ( = 0.001). Regarding associations between clinical factors and current practices, more years in practice trended towards less referrals and testing. Evaluating a greater number of patients ( = 0.11) and greater confidence recognizing syndromic features ( = 0.12) and ordering the correct test ( = 0.09) were all associated with ordering more testing.
CONCLUSION
Testing for microdeletion syndromes is being offered and completed in the ACHD population, however testing for single-gene disorders associated with CHD is being under-utilized. Developing guidelines for genetic testing in adults with CHD could increase access to genetic services, impact medical management, reduce uncertainty regarding prognosis, and inform recurrence risk estimates.
PubMed: 38803543
DOI: 10.3389/fgene.2024.1398887 -
Frontiers in Immunology 2024The systemic inflammatory response index (SIRI) is a novel inflammatory-immune biological marker that has prognostic value in various cardiovascular diseases. This study...
BACKGROUND
The systemic inflammatory response index (SIRI) is a novel inflammatory-immune biological marker that has prognostic value in various cardiovascular diseases. This study aims to investigate the relationship between SIRI and short-term and long-term prognosis in patients with acute type A aortic dissection (AAAD) underwent surgical treatment.
METHODS
We conducted a retrospective analysis of patients with AAAD who underwent emergency surgical treatment at our center. Through multifactorial logistics regression analysis and cox proportional hazards regression analysis, we identified SIRI as an independent risk factor for major adverse events (MAEs) and long-term aorta-related adverse events (ARAEs) post-surgery. The optimal cutoff value of preoperative SIRI was determined using receiver operating characteristic (ROC) curve analysis, and patients were divided into low SIRI group and high SIRI group. The prognostic outcomes at different time points post-surgery for the two groups of patients were analyzed using Kaplan-Meier survival analysis, and the significance was determined by log-rank test.
RESULTS
A total of 691 AAAD patients were included in this study. Among them, 50 patients (7.2%) died within 30 days post-surgery, and 175 patients (25.3%) experienced MAEs. A total of 641 patients were followed up, with an average follow-up time of 33.5 ± 17.5 months, during which 113 patients (17.6%) experienced ARAEs. The results of multifactorial logistics regression analysis and cox proportional hazards regression analysis showed that SIRI was an independent risk factor for postoperative MAEs (OR=3.148, 95%CI[1.650-6.006], <0.001) and ARAEs (HR=2.248, 95%CI[1.050-4.809], <0.037). Kaplan-Meier analysis demonstrated that the MAEs-free survival in the high SIRI group was significantly lower than that in the low SIRI group, and a similar trend was observed in the ARAEs-free survival during follow-up (log-rank test, <0.001).
CONCLUSION
Preoperative SIRI is significantly associated with the short-term and long-term prognosis of AAAD patients underwent emergency open surgery, demonstrating its valuable prognostic value. Therefore, preoperative SIRI is a reliable biological marker that can serve as a valuable tool for preoperative risk stratification and decision management.
Topics: Humans; Aortic Dissection; Male; Female; Middle Aged; Prognosis; Retrospective Studies; Aged; Risk Factors; Treatment Outcome; Biomarkers; Aortic Aneurysm; Kaplan-Meier Estimate; Acute Disease; Preoperative Period
PubMed: 38799451
DOI: 10.3389/fimmu.2024.1388109 -
Research Square May 2024Purpose Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data...
Purpose Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data are not currently available for ECG-gated Computed Tomography Angiography (CTA). We sought to establish ECG-gated CTA derived normative values for the aortic root, aorta and aortic arch in children. Methods and Results Aortic root, ascending aorta, aortic arch, and descending aorta were measured in systole and diastole in 100 subjects who had ECG-gated CTA at our center between January 2015 through December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface area (BSA ) was established using the previously described methods. Using this data, normalized mean, cross-sectional area, and standard deviation were calculated. Z-score curves were plotted in relation to the BSA for all measurements. Conclusion Our study reports systolic and diastolic ECG-gated CTA Z-scores along with normative curves in relation to BSA for the aortic root, aorta and aortic arch in children.
PubMed: 38798643
DOI: 10.21203/rs.3.rs-4406785/v1