Pilot study of the multicentre DISCHARGE Trial: image quality and protocol adherence results of computed tomography and invasive coronary angiography.
- 作者列表："De Rubeis G","Napp AE","Schlattmann P","Geleijns J","Laule M","Dreger H","Kofoed K","Sørgaard M","Engstrøm T","Tilsted HH","Boi A","Porcu M","Cossa S","Rodríguez-Palomares JF","Xavier Valente F","Roque A","Feuchtner G","Plank F","Štěchovský C","Adla T","Schroeder S","Zelesny T","Gutberlet M","Woinke M","Károlyi M","Karády J","Donnelly P","Ball P","Dodd J","Hensey M","Mancone M","Ceccacci A","Berzina M","Zvaigzne L","Sakalyte G","Basevičius A","Ilnicka-Suckiel M","Kuśmierz D","Faria R","Gama-Ribeiro V","Benedek I","Benedek T","Adjić F","Čanković M","Berry C","Delles C","Thwaite E","Davis G","Knuuti J","Pietilä M","Kepka C","Kruk M","Vidakovic R","Neskovic AN","Lecumberri I","Diez Gonzales I","Ruzsics B","Fisher M","Dewey M","Francone M","DISCHARGE Trial Group.
OBJECTIVE:To implement detailed EU cardiac computed tomography angiography (CCTA) quality criteria in the multicentre DISCHARGE trial (FP72007-2013, EC-GA 603266), we reviewed image quality and adherence to CCTA protocol and to the recommendations of invasive coronary angiography (ICA) in a pilot study. MATERIALS AND METHODS:From every clinical centre, imaging datasets of three patients per arm were assessed for adherence to the inclusion/exclusion criteria of the pilot study, predefined standards for the CCTA protocol and ICA recommendations, image quality and non-diagnostic (NDX) rate. These parameters were compared via multinomial regression and ANOVA. If a site did not reach the minimum quality level, additional datasets had to be sent before entering into the final accepted database (FADB). RESULTS:We analysed 226 cases (150 CCTA/76 ICA). The inclusion/exclusion criteria were not met by 6 of the 226 (2.7%) datasets. The predefined standard was not met by 13 of 76 ICA datasets (17.1%). This percentage decreased between the initial CCTA database and the FADB (multinomial regression, 53 of 70 vs 17 of 75 [76%] vs [23%]). The signal-to-noise ratio and contrast-to-noise ratio of the FADB did not improve significantly (ANOVA, p = 0.20; p = 0.09). The CTA NDX rate was reduced, but not significantly (initial CCTA database 15 of 70 [21.4%]) and FADB 9 of 75 [12%]; p = 0.13). CONCLUSION:We were able to increase conformity to the inclusion/exclusion criteria and CCTA protocol, improve image quality and decrease the CCTA NDX rate by implementing EU CCTA quality criteria and ICA recommendations. KEY POINTS:• Failure to meet protocol adherence in cardiac CTA was high in the pilot study (77.6%). • Image quality varies between sites and can be improved by feedback given by the core lab. • Conformance with new EU cardiac CT quality criteria might render cardiac CTA findings more consistent and comparable.
目的: 为了在多中心出院试验 (FP72007-2013，EC-GA 603266) 中实施详细的欧盟心脏计算机断层扫描血管造影术 (CCTA) 质量标准，我们在一项试点研究中回顾了图像质量和对CCTA方案的依从性以及对侵入性冠状动脉造影术 (ICA) 的建议。 材料和方法: 从每个临床中心，评估每组3名患者的成像数据集是否符合初步研究的纳入/排除标准、CCTA方案和ICA建议的预定标准、图像质量和非诊断 (NDX) 率。通过多项回归和ANOVA比较这些参数。如果一个站点没有达到最低质量水平，在进入最终接受的数据库 (FADB) 之前，必须发送额外的数据集。 结果: 我们分析了226例 (150 CCTA/76 ICA)。226个数据集中的6个 (2.7%) 未满足纳入/排除标准。76个ICA数据集中的13个 (17.1%) 未满足预定义的标准。该百分比在初始CCTA数据库和FADB之间下降 (多项回归，70中的53对75中的17 [76%] 对 [23%])。FADB的信噪比和对比噪声比没有显著改善 (ANOVA，p = 0.20; p = 0.09)。CTA NDX率降低，但不显著 (初始CCTA数据库15/70 [21.4%]) 和FADB 9/75 [12%]; p = 0.13)。 结论: 通过实施欧盟CCTA质量标准和ICA建议，我们能够提高对纳入/排除标准和CCTA方案的一致性，改善图像质量并降低CCTA NDX率。 关键点: • 在试点研究中，心脏CTA未能满足方案依从性较高 (77.6%)。•图像质量因地点而异，可以通过核心实验室给出的反馈来改善。•符合新的欧盟心脏CT质量标准可能会使心脏CTA结果更加一致和可比。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.