Gudrun Feuchtner

University of Innsbruck, Innsbruck, Tyrol, Austria

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Publications (179)578.47 Total impact

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    ABSTRACT: Conventional hybrid revascularization (CHR) combines minimally invasive placement of an internal mammary artery graft to the anterior wall and percutaneous coronary intervention (PCI) of non-anterior wall targets. In this study we assess perioperative and midterm outcomes of advanced hybrid revascularization (AHR) defined as the combination of single or multivessel (MV) totally endoscopic coronary artery bypass grafting (TECAB) with single or multivessel PCI.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 09/2014; · 2.40 Impact Factor
  • Wolfgang Dichtl, Gudrun Maria Feuchtner
    Wiener klinische Wochenschrift. 09/2014;
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    ABSTRACT: All participants for image samplings provided written informed consent. Conventional B-mode ultrasonography (US) has been widely utilized for musculoskeletal problems as a first-line approach because of the advantages of real-time access and the relatively low cost. The biomechanical properties of soft tissues reflect to some degree the pathophysiology of the musculoskeletal disorder. Sonoelastography is an in situ method that can be used to assess the mechanical properties of soft tissue qualitatively and quantitatively through US imaging techniques. Sonoelastography has demonstrated feasibility in the diagnosis of cancers of the breast and liver, and in some preliminary work, in several musculoskeletal disorders. The main types of sonoelastography are compression elastography, shear-wave elastography, and transient elastography. In this article, the current knowledge of sonoelastographic techniques and their use in musculoskeletal imaging will be reviewed. © RSNA, 2014.
    Radiology 09/2014; 272(3):622-633. · 6.34 Impact Factor
  • Radiology 09/2014; 272(3):622-633. · 6.34 Impact Factor
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    ABSTRACT: Purpose To determine the clinical outcomes of women and men with nonobstructive coronary artery disease (CAD) with coronary computed tomographic (CT) angiography data in patients who were similar in terms of CAD risk factors, angina typicality, and CAD extent and distribution. Materials and Methods Institutional review board approval was obtained for all participating sites, with either informed consent or waiver of informed consent. In a prospective international multicenter cohort study of 27 125 patients undergoing coronary CT angiography at 12 centers, 18 158 patients with no CAD or nonobstructive (<50% stenosis) CAD were examined. Men and women were propensity matched for age, CAD risk factors, angina typicality, and CAD extent and distribution, which resulted in a final cohort of 11 462 subjects. Nonobstructive CAD presence and extent were related to incident major adverse cardiovascular events (MACE), which were inclusive of death and myocardial infarction and were estimated by using multivariable Cox proportional hazards models. Results At a mean follow-up ± standard deviation of 2.3 years ± 1.1, MACE occurred in 164 patients (0.6% annual event rate). After matching, women and men experienced identical annualized rates of myocardial infarction (0.2% vs 0.2%, P = .72), death (0.5% vs 0.5%, P = .98), and MACE (0.6% vs 0.6%, P = .94). In multivariable analysis, nonobstructive CAD was associated with similarly increased MACE for both women (hazard ratio: 1.96 [95% confidence interval {CI}: 1.17, 3.28], P = .01) and men (hazard ratio: 1.77 [95% CI: 1.07, 2.93], P = .03). Conclusion When matched for age, CAD risk factors, angina typicality, and nonobstructive CAD extent, women and men experience comparable rates of incident mortality and myocardial infarction. © RSNA, 2014 Online supplemental material is available for this article.
    Radiology 07/2014; · 6.34 Impact Factor
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    ABSTRACT: Purpose To assess whether gradations of left ventricular (LV) ejection fraction (LVEF) and volumes measured with coronary computed tomography (CT) would augment risk stratification and discrimination for incident mortality. Materials and Methods This study was approved by the institutional review board, and informed consent was obtained when required. Subjects without known coronary artery disease (CAD) who underwent cardiac CT angiography with quantitative LV measurements were categorized according to LVEF (≥55%, 45%-54.9%, 35%-44.9%, or <35%). LV end-systolic volume (LVESV) and LV end-diastolic volume (LVEDV) were classified as normal (≥90 mL) or abnormal (≥200 mL). CAD extent and severity was categorized as none, nonobstructive, obstructive (≥50%), one-vessel, two-vessel, and three-vessel or left main disease. LVEF and volumes were assessed for risk prediction and discrimination of future mortality by using Cox hazards model and receiver operating characteristic curve analysis, respectively. Results During a follow-up of 2.0 years ± 0.9, 7758 patients (mean age, 58.5 years ± 13.0; 4220 male patients [54.4%]) were studied. At multivariable analysis, worsening LVEF was independently associated with mortality for moderately (hazard ratio = 3.14, P < .001) and severely (hazard ratio = 5.19, P < .001) abnormal ejection fraction. LVEF demonstrated improved discrimination for mortality (Az = 0.816) when compared with CAD risk factors alone (Az = 0.781) or CAD risk factors plus extent and severity. At multivariable analysis of a subgroup of 3706 individuals, abnormal LVEDV (hazard ratio = 4.02) and LVESV (hazard ratio = 6.46) helped predict mortality (P < .001). Similarly, LVESV and LVEDV demonstrated improved discrimination when compared with CAD risk factors or CAD extent and severity (P < .05). Conclusion LV dysfunction and volumes measured with cardiac CT angiography augment risk prediction and discrimination for future mortality. © RSNA, 2014.
    Radiology 07/2014; · 6.34 Impact Factor
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    ABSTRACT: Prior studies evaluating the prognostic utility of cardiac CT angiography (CCTA) have been largely constrained to an all-cause mortality endpoint, with other cardiac endpoints generally not reported. To this end, we sought to determine the relationship of extent and severity of coronary artery disease (CAD) by CCTA to risk of incident major adverse cardiac events (MACEs) (defined as death, myocardial infarction, and late revascularization). We identified subjects without prior known CAD who underwent CCTA and were followed for MACE. CAD by CCTA was defined as none (0% luminal stenosis), mild (1-49% luminal stenosis), moderate (50-69% luminal stenosis), or severe (≥70% luminal stenosis), and ≥50% luminal stenosis was considered as obstructive. CAD severity was judged on per-patient, per-vessel, and per-segment basis. Time to MACE was estimated using univariable and multivariable Cox proportional hazards models. Among 15 187 patients (57 ± 12 years, 55% male), 595 MACE events (3.9%) occurred at a 2.4 ± 1.2 year follow-up. In multivariable analyses, an increased risk of MACE was observed for both non-obstructive [hazard ratio (HR) 2.43, P < 0.001] and obstructive CAD (HR: 11.21, P < 0.001) when compared with patients with normal CCTA. Risk-adjusted MACE increased in a dose-response relationship based on the number of vessels with obstructive CAD ≥50%, with increasing hazards observed for non-obstructive (HR: 2.54, P < 0.001), obstructive one-vessel (HR: 9.15, P < 0.001), two-vessel (HR: 15.00, P < 0.001), or three-vessel or left main (HR: 24.53, P < 0.001) CAD. Among patients stratified by age <65 vs. ≥65 years, older individuals experienced higher risk-adjusted hazards for MACE for non-obstructive, one-, and two-vessel, with similar event rates for three-vessel or left main (P < 0.001 for all) compared with normal individuals age <65. Finally, there was a dose relationship of CAD findings by CCTA and MACE event rates with each advancing decade of life. Among individuals without known CAD, non-obstructive, and obstructive CAD are associated with higher MACE rates, with different risk profiles based on age.
    European heart journal cardiovascular Imaging. 05/2014; 15(5):586-94.
  • European heart journal cardiovascular Imaging. 03/2014;
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    ABSTRACT: Coronary artery calcium (CAC) is a well-established predictor of clinical outcomes for population screening. Limited evidence is available as to its predictive value in symptomatic patients without obstructive coronary artery disease (CAD). The aim of the current study was to assess the prognostic value of CAC scores among symptomatic patients with nonobstructive CAD. From the COronary Computed Tomographic Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 7,200 symptomatic patients with nonobstructive CAD (<50% coronary stenosis) on coronary-computed tomographic angiography were prospectively enrolled and followed for a median of 2.1 years. Patients were categorized as without (0% stenosis) or with (>0% but <50% coronary stenosis) a luminal stenosis. CAC scores were calculated using the Agatston method. Univariable and multivariable Cox proportional hazard models were employed to estimate all-cause mortality and/or myocardial infarction (MI). Four-year death and death or MI rates were 1.9% and 3.3%. Of the 4,380 patients with no luminal stenosis, 86% had CAC scores of <10 while those with a luminal stenosis had more prevalent and extensive CAC with 31.9% having a CAC score of ≥100. Among patients with no luminal stenosis, CAC was not predictive of all-cause mortality (P = .44). However, among patients with a luminal stenosis, 4-year mortality rates ranged from 0.8% to 9.8% for CAC scores of 0 to ≥400 (P < .0001). The mortality hazard was 6.0 (P = .004) and 13.3 (P < .0001) for patients with a CAC score of 100-399 and ≥400. In patients with a luminal stenosis, CAC remained independently predictive in all-cause mortality (P < .0001) and death or MI (P < .0001) in multivariable models containing CAD risk factors and presenting symptoms. CAC allows for the identification of those at an increased hazard for death or MI in symptomatic patients with nonobstructive disease. From the CONFIRM registry, the extent of CAC was an independent estimator of long-term prognosis among symptomatic patients with luminal stenosis and may further define risk and guide preventive strategies in patients with nonobstructive CAD.
    Journal of Nuclear Cardiology 03/2014; · 2.85 Impact Factor
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    ABSTRACT: Purpose To compare the elasticity of the median nerve (MN) between healthy volunteers and patients with carpal tunnel syndrome (CTS) and to evaluate the diagnostic utility of sonoelastographic measurements of the elasticity of the MN. Materials and Methods This study was performed with institutional review board approval and written informed consent from all participants. Hands in 22 healthy volunteers and in 31 patients with symptomatic CTS were studied. The cross-sectional area (CSA) and the elasticity of the MN, which was measured as the acoustic coupler (AC)/MN strain ratio, were evaluated. Results Both hands in 22 healthy volunteers (three men [mean age, 52.7 years; age range, 41-65 years]; 19 women [mean age, 62.2 years; age range, 40-88 years]) and 43 hands in 31 patients with symptomatic CTS (three men [mean age, 69.0 years; age range, 46-88 years]; 28 women [mean age, 61.2 years; age range, 39-92 years]) were studied. Both the AC/MN strain ratio and the CSA in the patients with CTS were significantly higher than those in the healthy volunteers (P < .001). The presence of CTS was predicted by means of AC/MN strain ratio and CSA cutoff values, respectively, of 4.3 and 11 mm(2), with areas under the receiver operating characteristic curves (AUCs) of 0.78 (95% confidence interval [CI]: 0.69, 0.88) and 0.85 (95% CI: 0.78, 0.93). A logistic model that combined the AC/MN strain ratio and the CSA improved diagnostic accuracy for CTS, with an AUC of 0.91 (95% CI: 0.85, 0.97; P < .001). Conclusion Sonoelastography provides significant improvement in the diagnostic accuracy of the ultrasonographic assessment of CTS. © RSNA, 2013.
    Radiology 02/2014; 270(2):481-6. · 6.34 Impact Factor
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    ABSTRACT: BACKGROUND: Short-term risk scores, such as the Framingham risk score (FRS), frequently classify younger patients as low risk despite the presence of uncontrolled cardiovascular risk factors. Among patients with low FRS, estimation of lifetime risk is associated with significant differences in coronary arterial calcium scores (CACS); however, the relationship of lifetime risk to coronary atherosclerosis on coronary CT angiography (CCTA) and prognosis has not been studied. METHODS AND RESULTS: We evaluated asymptomatic 20-60-year-old patients without diabetes or known coronary artery disease (CAD) within an international CT registry who underwent ≥64-slice CCTA. Patients with low FRS (<10%) were stratified as low (<39%) or high (≥39%) lifetime CAD risk, and compared for the presence and severity of CAD and prognosis for death, myocardial infarction, and late coronary revascularization (>90 days post CCTA). 1,863 patients of mean age of 47 years were included, with 48% of the low FRS patients at high lifetime risk. Median follow-up was 2.0 years. Comparing low-to-high lifetime risk, respectively, the prevalence of any CAD was 32% vs 41% (P < .001) and ≥50% stenosis was 7.4% vs 9.6% (P = .09). For those with CAD, subjects at low vs high lifetime risk had lower CACS (median 12 [IQR 0-94] vs 38 [IQR 0.05-144], P = .02) and less purely calcified plaque, 35% vs 45% (P < .001). Prognosis did not differ due to low number of events. CONCLUSION: Assessment of lifetime risk among patients at low FRS identified those with the increase in CAD prevalence and severity and a higher proportion of calcified plaque.
    Journal of Nuclear Cardiology 01/2014; 21(1):29-37. · 2.85 Impact Factor
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    ABSTRACT: Background Coronary artery disease (CAD) diagnosis by coronary computed tomographic angiography (CCTA) is useful for identification of symptomatic diabetic individuals at heightened risk for death. Whether CCTA-detected CAD enables improved risk assessment of asymptomatic diabetic individuals beyond clinical risk factors and coronary artery calcium scoring (CACS) remains unexplored. Methods From a prospective 12-center international registry of 27,125 individuals undergoing CCTA, we identified 400 asymptomatic diabetic individuals without known CAD. Coronary stenosis by CCTA was graded as 0%, 1–49%, 50–69%, and ≥70%. CAD was judged on a per-patient, per-vessel and per-segment basis as maximal stenosis severity, number of vessels with ≥50% stenosis, and coronary segments weighted for stenosis severity (segment stenosis score), respectively. We assessed major adverse cardiovascular events (MACE) – inclusive of mortality, nonfatal myocardial infarction (MI), and late target vessel revascularization ≥90 days (REV) – and evaluated the incremental utility of CCTA for risk prediction, discrimination and reclassification. Results Mean age was 60.4 ± 9.9 years; 65.0% were male. At a mean follow-up 2.4 ± 1.1 years, 33 MACE occurred (13 deaths, 8 MI, 12 REV) [8.25%; annualized rate 3.4%]. By univariate analysis, per-patient maximal stenosis [hazards ratio (HR) 2.24 per stenosis grade, 95% confidence interval (CI) 1.61–3.10, p < 0.001], increasing numbers of obstructive vessels (HR 2.30 per vessel, 95% CI 1.75–3.03, p < 0.001) and segment stenosis score (HR 1.14 per segment, 95% CI 1.09–1.19, p < 0.001) were associated with increased MACE. After adjustment for CAD risk factors and CACS, maximal stenosis (HR 1.80 per grade, 95% CI 1.18–2.75, p = 0.006), number of obstructive vessels (HR 1.85 per vessel, 95% CI 1.29–2.65, p < 0.001) and segment stenosis score (HR 1.11 per segment, 95% CI 1.05–1.18, p < 0.001) were associated with increased risk of MACE. Beyond age, gender and CACS (C-index 0.64), CCTA improved discrimination by maximal stenosis, number of obstructive vessels and segment stenosis score (C-index 0.77, 0.77 and 0.78, respectively). Similarly, CCTA findings improved risk reclassification by per-patient maximal stenosis [integrated discrimination improvement (IDI) index 0.03, p = 0.03] and number of obstructive vessels (IDI index 0.06, p = 0.002), and by trend for segment stenosis score (IDI 0.03, p = 0.06). Conclusion For asymptomatic diabetic individuals, CCTA measures of CAD severity confer incremental risk prediction, discrimination and reclassification on a per-patient, per-vessel and per-segment basis.
    Atherosclerosis 01/2014; 232(2):298–304. · 3.71 Impact Factor
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    ABSTRACT: Objectives To assess the diagnostic accuracy of standard axial 64-Slice chest CT compared to aortic valve image plane ECG-gated cardiac CT for bicuspid aortic valves. Materials & Methods The standard axial chest CT scans of 20 patients with known bicuspid aortic valves were blindly, randomly analysed for (i) the appearance of the valve cusps, (ii) the largest aortic sinus area, (iii) the longest aortic cusp length, (iv) the thickest aortic valve cusp and (v) valve calcification. A second blinded reader independently analysed the appearance of the valve cusps. Forty-two age- and sex-matched patients with known tricuspid aortic valves were used as controls. Retrospectively ECG-gated cardiac CT multiphase reconstructions of the aortic valve were used as the gold-standard. Results Fourteen (21%) scans were scored as unevaluable (7 bicuspid, 7 tricuspid). Of the remainder, there were 13 evaluable bicuspid valves, ten of which showed an aortic valve line sign, while the remaining three showed a normal Mercedes-benz appearance owing to fused valve cusps. The 35 evaluable tricuspid aortic valves all showed a normal Mercedes-benz appearance (P = 0.001). Kappa analysis = 0.62 indicating good interobserver agreement for the aortic valve cusp appearance. Aortic sinus areas, aortic cusp lengths and aortic cusp thicknesses of ≥ 3.8 cm2, 3.2 cm and 1.6 mm respectively on standard axial chest CT best distinguished bicuspid from tricuspid aortic valves (P < 0.0001 for all). Of evaluable scans, the sensitivity, specificity, positive and negative predictive values of standard axial chest CT in diagnosing bicuspid aortic valves was 77% (CI 0.54-1.0%), 100%, 100% and 70% respectively. Conclusion The aortic valve is evaluable in approximately 80% of standard chest 64-slice CT scans. Bicuspid aortic valves may be diagnosed on evaluable scans with good diagnostic accuracy. An aortic valve line sign, enlarged aortic sinuses and elongated, thickened valve cusps are specific CT features.
    European Journal of Radiology. 01/2014;
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    ABSTRACT: To prospectively assess the value of coronary CT angiography (CTA) in asymptomatic patients with high 'a priori' risk of coronary artery disease (CAD).
    Open heart. 01/2014; 1(1):e000096.
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    ABSTRACT: No abstract available
    European Heart Journal 12/2013; · 14.72 Impact Factor
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    ABSTRACT: The impact of paravalvular aortic regurgitation (PAR) on hemodynamic performance after transcatheter aortic valve implantation (TAVI) remains disputable. Common parameters such as the diastolic blood pressure or the blood pressure amplitude do not provide reproducible results. The aim of our study was to evaluate the impact of PAR on hemodynamics and outcome using the relative amplitude index (RAI). PAR was prospectively evaluated by echocardiography before discharge in 110 patients. The RAI was calculated according to the formula: RAI = [(Post-TAVI BP amplitude)/(Post-TAVI SBP) - (Pre-TAVI BP amplitude)/(Pre-TAVI SBP)] × 100%, where BP is blood pressure and SBP is systolic blood pressure. Correlations of increased RAI with perioperative outcome were investigated and factors influencing mortality were isolated. The incidence of moderate and severe PAR after TAVI was 9% and 1%, respectively. Diastolic pressure or post-TAVI amplitude did not correlate to perioperative outcome. RAI increased from 2 when PAR was <2+ to 7 when PAR was ≥2+ (P = .006). A cut-off value of RAI ≥14 was associated with increased perioperative mortality (29 vs 5%; P = .013) and acute renal injury requiring dialysis (71 vs 18%; P = .001). RAI ≥14 was also associated with higher follow-up mortality at 1 year (57 vs 16%; P = .007). RAI ≥14 (odds ratio [OR], 3.390; 95% confidence interval [CI], 1.6-7.194; P = .00146), PAR ≥2+ (OR, 4.717; 95% CI, 1.828-12.195; P = .00135), and perioperative renal replacement therapy (OR, 12.820; 95% CI, 5.181-31.250; P = .00031) were found to be independent predictors of mortality at 1 year. The RAI is a useful tool to predict perioperative and 1-year outcome in patients with PAR after TAVI.
    The Journal of thoracic and cardiovascular surgery 12/2013; · 3.41 Impact Factor
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    ABSTRACT: PURPOSE Coronary artery disease (CAD) detected by coronary computed tomographic angiography (CCTA) has been shown to predict death and major adverse cardiac events (MACE) in men and women. To date, potential difference in gender-based prognostic utility of non-obstructive CAD identified on CCTA for myocardial infarction and death has not been adequately examined METHOD AND MATERIALS From an international multicenter observational cohort study of 27,725 individuals consecutively undergoing CCTA from 12 centers, we identified 18,158 patients without known CAD with normal CCTA or non-obstructive disease (defined as <50% diameter stenosis). Non-obstructive CAD presence and extent (segment involvement score) was related to incident MACE—inclusive of death, and myocardial infarction— using multivariable Cox proportional hazards models in addition propensity matching for cardiac risk factors and SIS was performed. RESULTS At a 2.3 + 1.1-year follow-up, MACE occurred in 251 patients (0.6% annual event rate). Women were more likely to be dyslipidemic, hypertensive, diabetic and have a family history of CAD (p<0.001 for all), while men were more likely to have higher Framingham risk score (p<0.001) In multivariable analysis, non-obstructive CAD was associated with a hazard ratio [HR] of 1.83 (95% confidence interval: 1.1-3.0, p=0.02) in men and an HR of 1.84 (1.1-3.0, p=0.02) in women for MACE. After propensity matching for risk factors and segment involvement score, non-obstructive disease conferred the same risk for men and women for both MI (p=0.89) and death/MI (p=0.90). Kaplan-Meier MACE-free survival estimates for risk factors, symptoms, and number of coronary segments with non-obstructive CAD were similar between men and women (p=0.94). The absence of CAD was associated with similar lowannualized rate of events (Men 0.3% and women 0.4%, respectively; p=0.20). When propensity matched non-obstructive disease is also associated with a similar event rate between men and women (Men 0.8% vs Women 0.9% p=0.89) CONCLUSION Non-obstructive CAD on CCTA confers similar risk of death and myocardial infarction in men and women when matched for underlying cardiovascular risk. The absence of plaque is associated with a similarly low event rate in men and women. CLINICAL RELEVANCE/APPLICATION Our data confirms similar risk of non-obstructive CAD on CCTA between men and women helping to better understand CAD related sex differences.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: PURPOSE To prospectively compare non-calcified plaque delineation and image quality of coronary artery computed tomography angiograms (CCTA) obtained with sonogram-affirmed iterative reconstruction (SAIR) with different strengths and filtered back projection (FBP). METHOD AND MATERIALS A total of 53 patients (body weight 90.4±21.6 kg, BMI 29.5±6.6) were investigated. CCTA was performed using 128-slice dual-source CT. Images were reconstructed with standard FBP and sonogram-affirmed iterative reconstruction using different strength (I2f, I3f, I4f). Image quality score (IQS) of overall CCTA exam and a non-calcified plaque outer border delineation scores (PDS) were evaluated respectively by using a 5-scale score: from 1= non-diagnostic to 5=excellent. Image noise, contrast-to-noise ratio (CNR) of aorta root, left main and right coronary artery proximal part, and the non-calcified plaques were quantified and compared among the 4 image reconstructions. IQS and PDS were compared between different BMI groups (BMI<28 and ≥28). RESULTS There were 69.8% patients in FBP, 98.0% in I2f, 98.1% in I3f and 100% in I4f who had good overall CCTA IQS. There were statistical differences in CCTA exam IQS among the 4 image reconstructions (P<0.01). There were 60 non-calcified plaques by I2f-I4f, out of those 11 (18.3%) plaques were missed by FBP. PDS increased constantly from FBP (2.7±0.4) to I2f (3.2±0.3), to I3f (3.5±0.3) up to I4f (4.0±0.4), while CNRs of the non-calcifying plaque increased and image noise decreased, respectively. Similarly, CNR of aortic root, left main and right coronary artery improved and image noise declined from FBP to I2f, I3f and I4f. IQS improvements were consistent in low and high BMI groups, however, PDS improvement were greater in high BMI group>28 (P<0.05). The improvements in IQS were more obviously between FBP and SAIR other than comparison among SAIR with different strength. I4f revealed the highest IQS and PDS. CONCLUSION SAIR offers improved image quality and non-calcifying plaque delineation as compared with FBP, especially if BMI is increasing. Importantly, 18.3% of non-calcifying plaques were missed with FBP but detected by SAIR. I4f shows the best IQS and PDS among the different SAIR strength. CLINICAL RELEVANCE/APPLICATION SAIR improves non-calcifying plaque delineation and detection, and image quality in CCTA. In high BMI patients, highest SAIR strength I4f is most beneficial.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: PURPOSE Cardiac allograft vasculopathy represents a major cause of mortality in the later course of cardiac transplant. CCTA represents a valuable non-invasive imaging tool in the diagnosis of cardiac allograft vasculopathy with the disadvantage of radiation burden. Radiation dose reduction in CCTA of cardiac transplant is challenging as patients often present with elevated heart rates. The aim of this prospective randomized study was to evaluate image quality, diagnostic confidence, and radiation dose using 3 different CT scan protocols for dual-source CCTA in heart transplant recipients. METHOD AND MATERIALS Dual source CCTA was performed in 150 consecutive patients after heart transplantation using either the conventional retrospective-triggered spiral technique (120 kV/320 mA, tube current modulation) in group 1, the prospective ECG-gated sequence technique (120 kV/320 mA, main padding window 40-70%) in group 2, or the prospective ECG-gated sequence technique in the systolic phase with automated tube voltage selection (Automated kV, main padding window 35-45%) in group 3. Subjective image quality was rated using a 16 segment coronary artery model and a four-point scale (1=excellent, 2= good, 3= fair, 4 = non-diagnostic) for each segment. Effective dose (ED) was used to compare the differences in radiation dose. RESULTS No difference was observed in subjective image quality between the study groups regarding segments with excellent or good image quality (Group 1: 90.5%, group 2: 89.3%; group 3: 86.8%). The number of segments with non-diagnostic image quality was lowest in group 3 (Group 1: 1.8%, group 2: 2.1%; group 3: 1.1%) and did not differ between group 1 and 2. Mean ED did not differ significantly between group 1 and group 2 (9.9±2.7 mSv vs. 9.1±2.3 mSv; p=0.13), but was significantly lower in group 3 (4.6±1.9 mSv; p<0.001 vs. group 1 and 2). CONCLUSION Radiation dose of dual source CCTA in heart transplant recipients can be significantly reduced by using the ECG-gated sequence technique in the systolic phase and automated tube voltage selection, compared to the ECG-gated sequence technique using a wide padding window and the conventional spiral technique, while diagnostic image quality is maintained. CLINICAL RELEVANCE/APPLICATION Coronary CTA in heart transplant patients can be performed using a scan technique with relevant dose reduction with maintained image quality compared to conventional scan modes with higher doses.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: No abstract
    JACC. Cardiovascular imaging 10/2013; · 14.29 Impact Factor

Publication Stats

2k Citations
578.47 Total Impact Points

Institutions

  • 2003–2014
    • University of Innsbruck
      • Institute of Biochemistry
      Innsbruck, Tyrol, Austria
  • 2013
    • Henry Ford Hospital
      Detroit, Michigan, United States
  • 2012–2013
    • University of British Columbia - Vancouver
      • Division of Cardiology
      Vancouver, British Columbia, Canada
    • Emory University
      • School of Medicine
      Atlanta, GA, United States
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Angeles, CA, United States
    • Brigham and Women's Hospital
      • Center for Brain Mind Medicine
      Boston, MA, United States
    • Baptist hospital of Miami
      Miami, Florida, United States
  • 2004–2013
    • Medizinische Universität Innsbruck
      • • Sektion für Histologie und Embrylogie
      • • Univ.-Klinik für Radiologie
      • • Universitätsklinik für Herzchirurgie
      Innsbruck, Tyrol, Austria
  • 2009–2011
    • Massachusetts General Hospital
      • • Division of Cardiology
      • • Department of Radiology
      Boston, MA, United States
    • University of Zurich
      • Center for Integrative Human Physiology
      Zürich, ZH, Switzerland
    • University of Florida
      • Department of Radiology
      Gainesville, FL, United States
  • 2009–2010
    • Medical University of Vienna
      • Universitätsklinik für Radiodiagnostik
      Vienna, Vienna, Austria