Publications (10)37.64 Total impact
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Article: Incremental value of myocardial perfusion over regional left ventricular function and coronary stenosis by cardiac CT for the detection of acute coronary syndromes in high-risk patients: a subgroup analysis of the ROMICAT trial.
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ABSTRACT: To determine the incremental benefit of assessing myocardial perfusion defects (MPD) for acute coronary syndromes (ACS) over coronary and functional assessment by rest cardiac computed tomography (CT) in patients with acute chest pain. Assessment of myocardial perfusion is feasible with cardiac CT; however, the diagnostic value of this assessment in patients at risk for ACS has not been demonstrated. The study included patients who presented to the emergency department with acute chest pain, nonischemic initial electrocardiogram (ECG), and negative cardiac biomarkers but had clinical suspicion for ACS and underwent invasive coronary angiography (ICA). Results were blinded to caregivers and patients. CT data sets were independently assessed for the presence of coronary plaque and stenosis, regional left ventricular function, and myocardial perfusion deficits by 2 blinded observers. Coronary angiography was assessed for the presence of stenosis, TIMI myocardial perfusion grade, and corrected TIMI frame count. The endpoint was ACS during index hospitalization. We analyzed data from 35 subjects (69% male, mean age 58 ± 9 years) of whom 22 (63%) had ACS. The sensitivity and specificity of MPD for ACS were 86% (95% CI: 64%-96%) and 62% (95% CI: 32%-85%), respectively. Combined, MPD and RWMA assessment resulted in specificity and sensitivity of 86% (95% CI: 64%-96%) and 85% (95% CI: 54%-97%), respectively. Adding MPD and RWMA to the assessment for significant stenosis (>50%) resulted in a higher sensitivity of 91% (69-98%) and specificity of 85% (54-97%) and a significantly increased overall diagnostic accuracy when compared with assessment for stenosis (AUC: 0.88 vs 0.79; respectively, P = 0.02). Diagnostic accuracy of CT was not associated with impaired CTFC >40 or myocardial TIMI perfusion grade < 3. Assessment of myocardial perfusion and regional wall motion abnormalities may enhance the ability of CT to detect ACS in patients with acute chest pain.Journal of cardiovascular computed tomography 11/2011; 5(6):382-91. -
Article: Quantification of coronary stenosis by dual source computed tomography in patients: a comparative study with intravascular ultrasound and invasive angiography.
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ABSTRACT: To determine the accuracy of dual-source CT (DSCT) to quantify coronary stenosis compared to intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA). 21 patients (23 vessels) were examined with DSCT, IVUS and invasive coronary angiography. Coronary minimal luminal diameter (MLD) and area (MLA) were measured in cross-sectional multi-planar reformatted images perpendicular to the vessel long-axis. The vessel cross-sectional area stenosis (MLA/CSA ratio) was calculated. DSCT results were compared with IVUS and QCA. A good correlation between DSCT and IVUS was noted for diameter and area stenosis (r=0.69 and r=0.73), with an overestimation of MLD stenosis by DSCT (+9.1%) and an underestimation of MLA stenosis (-5.8%). For MLD and MLA, high correlation coefficients (r=0.78 and r=0.90, respectively) were found between DSCT and IVUS; and the bias was almost zero (-0.41 mm and +0.1mm(2), respectively). The correlation between DSCT and QCA was moderate (r=0.60) for MLD stenosis with minor overestimation by DSCT (+4.0%) and moderate (r=0.59) for MLD (bias, +0.01 mm). The cross-sectional area stenosis showed a moderate correlation (r=0.59) between DSCT and IVUS (+0.00). DSCT allows accurate quantification of coronary stenosis as compared to IVUS. An excellent correlation was found for the MLA between DSCT and IVUS.European journal of radiology 01/2011; 81(1):83-8. · 2.65 Impact Factor -
Article: Tuberculous pseudoaneurysms of the thoracic aorta: comprehensive evaluation by cardiovascular magnetic resonance.
Circulation 12/2009; 120(24):e285-7. · 14.74 Impact Factor -
Article: Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography.
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ABSTRACT: This study sought to determine the feasibility of performing a comprehensive cardiac computed tomographic (CT) examination incorporating stress and rest myocardial perfusion imaging together with coronary computed tomography angiography (CTA). Although cardiac CT can identify coronary stenosis, very little data exist on the ability to detect stress-induced myocardial perfusion defects in humans. Thirty-four patients who had a nuclear stress test and invasive angiography were included in the study. Dual-source computed tomography (DSCT) was performed as follows: 1) stress CT: contrast-enhanced scan during adenosine infusion; 2) rest CT: contrast-enhanced scan using prospective triggering; and 3) delayed scan: acquired 7 min after rest CT. Images for CTA, computed tomography perfusion (CTP), and single-photon emission computed tomography (SPECT) were each read by 2 independent blinded readers. The DSCT protocol was successfully completed for 33 of 34 subjects (average age 61.4 +/- 10.7 years; 82% male; body mass index 30.4 +/- 5 kg/m(2)) with an average radiation dose of 12.7 mSv. On a per-vessel basis, CTP alone had a sensitivity of 79% and a specificity of 80% for the detection of stenosis > or =50%, whereas SPECT myocardial perfusion imaging had a sensitivity of 67% and a specificity of 83%. For the detection of vessels with > or =50% stenosis with a corresponding SPECT perfusion abnormality, CTP had a sensitivity of 93% and a specificity of 74%. The CTA during adenosine infusion had a per-vessel sensitivity of 96%, specificity of 73%, and negative predictive value of 98% for the detection of stenosis > or =70%. Adenosine stress CT can identify stress-induced myocardial perfusion defects with diagnostic accuracy comparable to SPECT, with similar radiation dose and with the advantage of providing information on coronary stenosis.Journal of the American College of Cardiology 09/2009; 54(12):1072-84. · 14.16 Impact Factor -
Article: Contrast-enhanced cine cardiac MR detects impairment of coronary microvascular perfusion in patients after acute myocardial infarct
Journal of Cardiovascular Magnetic Resonance. 01/2009; -
Article: Myocardial salvage by contrast-enhanced cine MR imaging: validation study against conventional T2 edema imaging and angiographic estimates of myocardium at risk during acute myocardial infarction
Journal of Cardiovascular Magnetic Resonance. 01/2009; -
Article: [Cardiovascular magnetic resonance and computed tomography imaging guidelines of the Brazilian Society of Cardiology].
Arquivos brasileiros de cardiologia 10/2006; 87(3):e60-100. · 1.32 Impact Factor -
Article: [I cardiovascular magnetic resonance and computed tomography guidelines of the Brazilian Society of Cardiologia - Executive summary].
Arquivos brasileiros de cardiologia 10/2006; 87(3):e48-59. · 1.32 Impact Factor -
Article: Diffusion imaging may predict reversible brain lesions in eclampsia and severe preeclampsia: initial experience.
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ABSTRACT: The purpose of this study was to validate diffusion-weighted magnetic resonance imaging in the prediction of the evolutive course of brain edema and to establish its pathophysiologic presence in patients with eclampsia/severe preeclampsia. Seventeen patients with a clinical diagnosis of severe eclampsia/preeclampsia and T2 hyperintense brain lesions on routine magnetic resonance imaging were evaluated at hospital admission and 8 weeks later. Brain edema was reversible in 13 patients and irreversible in 4 patients, as indicated on follow-up magnetic resonance imaging. Sixteen of 17 patients were differentiated accurately into reversible and irreversible groups on the basis of diffusion imaging on hospital admission. Diffusion-weighted magnetic resonance imaging demonstrated a significant increase in water mobility in abnormal regions compared with normal-appearing brains in patients in the reversible group (1.34+/-0.10 mm(2) vs 0.79+/-0.08 mm(2)/s x 10(-3), P<.001). In the irreversible group, restricted water diffusion was present, which was consistent with cytotoxic edema and early brain infarction in 3 of 4 patients. Diffusion-weighted magnetic resonance imaging can predict successfully the evolutive course of brain edema in an acute setting in these patients. Our findings indicate that brain edema is vasogenic, although ischemic/cytotoxic edema was observed less commonly.American Journal of Obstetrics and Gynecology 11/2003; 189(5):1350-5. · 3.47 Impact Factor -
Article: Assessment of nonstenotic coronary lesions by 64-slice multidetector computed tomography in comparison to intravascular ultrasound: evaluation of nonculprit coronary lesions.
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ABSTRACT: Multidetector computed tomography (MDCT) has recently emerged as a potential noninvasive alternative for high-resolution imaging of coronary arteries. In this study, we evaluated 64-slice MDCT for detection, quantification, and characterization of atherosclerotic plaque burden in nonculprit lesions. Data from 11 patients who underwent both MDCT and intravascular ultrasound (IVUS) for suspected coronary artery disease were collected, and a total of 17 coronary segments and 122 cross-sectional slices were analyzed by MDCT and IVUS. Coronary segments on MDCT were coregistered to IVUS, and each obtained slice was scored by 2 blinded observers for presence and type of plaque. Quantitative measurements included cross-sectional vessel area, lumen area, wall area, plaque volume, and plaque burden. Mean and standard deviation of Hounsfield units (HUs) were recorded for plaque when present. Overall sensitivity for plaque detection was 95.0%, and specificity, positive predictive value, negative predictive value were 88.7%, 89.1%, and 94.8%, respectively. Spearman's correlation coefficients were 0.85, 0.75, 0.70, 0.89, and 0.54 for cross-sectional vessel area, lumen area, wall area, plaque volume, and plaque burden, respectively. The interobserver variability for plaque burden and plaque volume measurements between readers on 64-MDCT was high at 32.7% and 30.4%, respectively. Combined noncalcified plaque had a mean MDCT density significantly different from that of calcified plaque. Soft and fibrous plaques were not able to be distinguished based on their HU values. Sixty-four-slice MDCT had good correlation with IVUS but with high interobserver variability. Plaque characterization remains a challenge with present MDCT technology.Journal of cardiovascular computed tomography 3(1):24-31.
Top co-authors
Top Journals
Institutions
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2009–2011
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Massachusetts General Hospital
- Division of Cardiology
Boston, MA, USA
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