Gudrun Feuchtner

• Prof. MD MBA (HCM)
• Professor (Associate) at Innsbruck Medical University

Prosthetic heart valve (PHV) dysfunction is increasingly seen due to the increase in the number of PHV that are being implanted worldwide. Cardiac CT imaging has emerged as a valuable tool to assess PHVs and determine the cause of dysfunction. This consensus document first summarizes the available techniques for PHV assessment. Then the use of CT i...

Pericoronary adipose tissue attenuation, a marker of coronary inflammation, shows minimal quantitative differences between patients with and without future incident acute coronary syndromes in a matched case-control multicenter cohort of patients who underwent coronary CT angiography but is independently associated with future incident acute corona...

Importance The effect of computed tomography (CT) vs invasive coronary angiography (ICA) on health status outcomes is unknown. Objective To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina. Design, Setting, and Participants The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of...

Background/Objectives: Large language models (LLMs), such as ChatGPT, have emerged as potential clinical support tools to enhance precision in personalized patient care, but their reliability in radiological image interpretation remains uncertain. The primary aim of our study was to evaluate the diagnostic accuracy of ChatGPT-4o in interpreting che...

Background: Coronary artery calcium (CAC) scoring is used to stratify acute coronary syndrome (ACS) risk. Nonetheless, patients with CAC score of zero (CAC0) remain at risk from noncalcified plaque components. Objective: To explore CTA-derived coronary artery plaque characteristics in symptomatic patients with CAC0 who experience subsequent ACS thr...

A 50 year-old-male presented with NSTEMI, a coronary fistula and a ruptured coronary aneurysm, which lead to fatal bleeding. The case highlights the pivotal role of coronary computed tomography angiography (CTA) in establishing the correct diagnosis based on CTA imaging findings.

Background: Coronary plaque features are imaging biomarkers of cardiovascular risk, but less is known about sex-specific patterns in their prognostic value. This study aimed to define sex differences in the coronary atherosclerotic phenotypes assessed by artificial intelligence-based quantitative coronary computed tomography (AI-QCT) and the associ...

Objectives: Prediction of lung function deficits following pulmonary infection is challenging and suffers from inaccuracy. We sought to develop machine-learning models for prediction of post-inflammatory lung changes based on COVID-19 recovery data. Methods: In the prospective CovILD study (n = 420 longitudinal observations from n = 140 COVID-19 su...

Background Stroke is a feared complication after TAVI. The objective was to assess whether left atrial appendage (LAA) filling-defect (FD) patterns from early and late-phase computed tomography (CT), predict stroke/TIA in patients with severe aortic stenosis. Methods 124 patients with severe aortic stenosis (79.5y, 46.8% females) who underwent CT-...

Background/Objective: Left atrial (LA) fibrosis imaging improves the guidance of LA catheter ablation. Cardiac computed tomography (CT) may be a reasonable alternative to CMR. The aim was to evaluate late enhancement (LE) fibrosis mapping by CT, and to correlate the results with low-voltage areas on electroanatomical mapping (EAM). Methods: In pati...

INTRODUCTION: Coronary CT angiography (CCTA) is a powerful noninvasive tool for identifying high-risk plaque, such as low-density non-calcified plaque (LD-NCP). Though, the optimal treatment of patients with LD-NCP remains unclear. This study explored the association of revascularization in the setting of LD-NCP with the occurrence of acute coronar...

(1) Background: The novel SARS-CoV-2 virus infects the endothelium. Vasculitis may lead to specific coronary artery wall lesions. Coronary computed tomography angiography (CTA) imaging findings have not been systematically reported. The aim of this study was to describe a case series using CTA. (2) Methods: Patients with recent RT-PCR confirmed SAR...

Objective Novel pericardial adipose tissue imaging biomarkers are currently under investigation for cardiovascular risk stratification. However, a specific compartment of the epicardial adipose tissue (EAT), lipomatous hypertrophy of the interatrial septum (LHIS), is included in the pericardial fat volume (PCFV) quantification software. Our aim was...

Background Cardiovascular risk (CV)-stratification in females is challenging, and current models miss a high proportion at-risk. Breast arterial calcifications (BAC) are independent prognosticators, but their interaction with the coronary artery disease profile by computed tomography (CT) is controverse, and the role of BAC 0 unclear. Objective to...

Objective Lipomatous hypertrophy of the interatrial septum (LHIS) is a distinct compartment of epicardial adipose tissue (EAT). However, its association with chronic obstructive pulmonary disease (COPD) is poorly documented. Methods Patients undergoing coronary CT angiography (CTA) for clinical indications were recruited retrospectively and screen...

Background: Despite being the most commonly performed valvular intervention, risk prediction for aortic valve replacement in patients with severe aortic stenosis by currently used risk scores remains challenging. The study aim was to develop a biomarker-based risk score by means of a neuronal network. Methods: In this multicenter study, 3595 patien...

Background Recently, monosodium urate (MSU) deposits were demonstrated in coronary arteries of 86.4% of gout patients by dual energy computed tomography (DECT).[1] Cardiovascular (CV) MSU deposits were associated with major adverse cardiac events (MACE) [2], but also the presence of peripheral MSU deposits increased the risk for CV disease and deat...

Purpose Endovascular aneurysm repair has emerged as the standard therapy for abdominal aortic aneurysms. In 9–30% of cases, retrograde filling of the aneurysm sac through patent branch arteries may result in persistence of blood flow outside the graft and within the aneurysm sac. This condition is called an endoleak type II, which may be treated by...

Purpose of Review To highlight novel findings in the detection of monosodium urate deposits in vessels using dual energy computed tomography, and to discuss the potential clinical implications for gout and hyperuricemia patients. Recent Findings Gout is an independent risk factor for cardiovascular disease. However, classical risk calculators do n...

Objective To determine the association of cardiovascular atherosclerotic plaque monosodium urate deposits with the occurrence of major cardiovascular events in gout and hyperuricemia patients. Methods This retrospective cohort study included patients with clinically suspicion of gout, who performed a dual energy computed tomography of the affected...

Photon-counting detector computed tomography (PCD-CT) represents a revolutionary new generation of computed tomography (CT) for the imaging of patients with cardiovascular diseases. Since its commercial market introduction in 2021, numerous studies have identified advantages of this new technology in the field of cardiovascular imaging, including i...

Latest research has indicated a potential adverse effect on graft patency rates and clinical outcomes with skeletonizing the left internal thoracic artery. We aim to provide a prospective, randomized, multicentre trial to compare skeletonized versus pedicled harvesting technique of left internal thoracic artery concerning graft patency rates and pa...

Background Coronary artery calcium (CAC) has prognostic value for major adverse cardiovascular events (MACE) in asymptomatic individuals, whereas its role in symptomatic patients is less clear. Purpose To assess the prognostic value of CAC scoring for MACE in participants with stable chest pain initially referred for invasive coronary angiography (...

Importance The effectiveness and safety of computed tomography (CT) and invasive coronary angiography (ICA) in different age groups is unknown. Objective To determine the association of age with outcomes of CT and ICA in patients with stable chest pain. Design, Setting, and Participants The assessor-blinded Diagnostic Imaging Strategies for Patie...

In the abstract of the article cited above, the clinical trial number for DISCHARGE (NCT02400229) was inadvertently omitted. The abstract has been revised to include the ClinicalTrials.gov identification. The editors apologize for the error. The online version of the article (https://doi.org/10.2337/dc23-0710) has been updated to correct the error.

Abstract When patients suspected of having coronary artery disease were stratified by body mass index category, no difference in clinical outcomes was observed between those who underwent initial management with CT and those who underwent invasive coronary angiography. Background Recent trials support the role of cardiac CT in the evaluation of...

OBJECTIVES Myocardial hypertrophy results in increased levels of cardiac biomarkers in healthy individuals and in patients suffering from acute myocardial infarction. The influence of cardiac mass on postoperative cardiac biomarkers release remains unclear. This study investigated the correlation between myocardial mass and the release of high-sens...

To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status. This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CA...

Introduction Previous analyses have reported the outcomes of transcatheter aortic valve replacement (TAVR) for patients with low-flow, low-gradient (LFLG) aortic stenosis (AS), without stratifying according to the route of access. Differences in mortality rates among access routes have been established for high-gradient (HG) patients and hypothesiz...

Background In the last 15 years, large registries and several randomized clinical trials have demonstrated the diagnostic and prognostic value of coronary computed tomography angiography (CCTA). Advances in CT scanner technology and developments of analytic tools now enable accurate quantification of coronary artery disease (CAD), including total c...

OBJECTIVE To compare cardiac computed tomography (CT) with invasive coronary angiography (ICA) as the initial strategy in patients with diabetes and stable chest pain. RESEARCH DESIGN AND METHODS This prespecified analysis of the multicenter DISCHARGE trial in 16 European countries was performed in patients with stable chest pain and intermediate...

Background Chronic respiratory diseases represent the third-leading cause of death on a global scale. Due to mutual symptoms with cardiovascular diseases and potential inappropriate attribution of symptoms, pulmonary diseases often remain undiagnosed. Therefore, we aimed to evaluate the prevalence of chronic respiratory disorders among symptomatic...

Background Gout is the most common inflammatory arthritis and doubles the risk of cardiovascular (CV) events.[1] Classical risk calculators like the Framingham risk score fail to sufficiently explain this higher hazard. [2] Recently, MSU deposits were demonstrated in coronary arteries of 86.4% of investigated gout patients and were positively assoc...

Aims: The totality of atherosclerotic plaque derived from coronary computed tomography angiography (CCTA) emerges as a comprehensive measure to assess the intensity of medical treatment that patients need. This study examines the differences in age onset and prognostic significance of atherosclerotic plaque burden between sexes. Methods and resul...

Background: Elevated coronary artery calcium (CAC) scores in subjects without prior atherosclerotic cardiovascular disease (ASCVD) have been shown to be associated with increased cardiovascular risk. Objectives: The authors sought to determine at what level individuals with elevated CAC scores who have not had an ASCVD event should be treated as...

Background: Calcific aortic valve disease (CAVD) is characterized by a phenotypic switch of valvular interstitial cells to bone-forming cells. Toll-like receptors (TLRs) are evolutionarily conserved pattern recognition receptors at the interface between innate immunity and tissue repair. Type I interferons (IFNs) are not only crucial for an adequa...

This review aims to summarize key articles published in the Journal of Cardiovascular Computed Tomography (JCCT) in 2022, focusing on those that had the most scientific and educational impact. The JCCT continues to expand; the number of submissions, published manuscripts, cited articles, article downloads, social media presence, and impact factor c...

Objectives As-low-as-diagnostically-acceptable (ALADA) doses are substantially lower than current diagnostic reference levels. To improve dose management, a reference quality approach was tested in which phantom quality metrics of a clinical ALADA dose reference protocol were used to benchmark potential ALADA dose protocols for various scanner mode...

Objectives: Mechanical strain plays a major role in the development of aortic calcification. We hypothesized that (a) valvular calcifications are most pronounced at the localizations subjected to the highest mechanical strain and (b) calcification patterns are different in patients with bicuspid and tricuspid aortic valves. Methods: Multi slice...

Introduction: Coronary artery calcium (CAC) score improves prognostic accuracy of atherosclerotic cardiovascular disease outcomes. However, the relative impact of statins on outcomes stratified by CAC score is limited. Methods: The open-label, 12-center, 6-country prospective longitudinal CONFIRM registry was queried. Individuals with severe CAC (≥...

Background Prognostic significance of non-obstructive left main (LM) disease was recently reported. However, the influence of diabetes mellitus (DM) on event rates in patients with and without non-obstructive LM disease is not well-known. Methods We evaluated 27,252 patients undergoing coronary computed tomographic angiography from the COroNary CT...

Background Absence of subclinical atherosclerosis is considered safe to defer statin therapy in general population. However, impact of statins on atherosclerotic cardiovascular disease in patients with diabetes stratified by coronary artery calcium (CAC) scores and extent of non-obstructive CAD on coronary computed tomography angiography (CCTA) has...

(1) Background: Whether it is safe to exclude coronary artery disease (CAD) in symptomatic patients with coronary artery calcium score (CACS 0), is an open debate. To compare coronary CTA including high-risk plaque (HRP) features in symptomatic patients with CACS 0 (2) Methods: 1709 symptomatic patients (age, mean 57.5 ± 16 years, 39.6% females) re...

Aims The temporal instability of coronary atherosclerotic plaque preceding an incident acute coronary syndrome (ACS) is not well defined. We sought to examine differences in the volume and composition of coronary atherosclerosis between patients experiencing an early (≤90 days) versus late ACS (>90 days) after baseline coronary computed tomography...

Cardiac computed tomography (CT) has evolved over the past 20 years from an alternative, promising noninvasive imaging modality to a Class I indication for the non-invasive evaluation of patients with low-to-intermediate, pre-test probability of coronary artery disease (CAD), as per the European Society of Cardiology (ESC) guidelines published in 2...

Purpose: We assessed the application of appropriate use criteria of coronary computed tomography angiography (CCTA) in comparison to invasive coronary angiography results and revascularization rates in patients with coronary artery disease (CAD). Methods: 1305 patients referred to invasive coronary angiography (ICA) after CCTA were evaluated retros...

Background: Dual-energy computed tomography (DECT) allows direct visualization of monosodium urate (MSU) deposits in joints and soft tissues. Purpose: To describe the distribution of MSU deposits in cadavers using DECT in the head, body trunk, and feet. Materials and Methods: A total of 49 cadavers (41 embalmed and 8 fresh cadavers; 20 male, 29 fem...

Background The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown. Objectives The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care...

Background We examined age differences in whole-heart volumes of non-calcified and calcified atherosclerosis by coronary computed tomography angiography (CCTA) of patients with future ACS. Methods A total of 234 patients with core-lab adjudicated ACS after baseline CCTA were enrolled. Atherosclerotic plaque was quantified and characterized from th...

Purpose: In this cohort study, 5-year data from the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry (ie, CONFIRM) were examined to identify associations of baseline aspirin and statin use with mortality, major adverse cardiovascular events (MACE), and myocardial infarction (MI) in individuals without...

Artificial Intelligence (AI)-based computed tomography (CT) image analysis has evolved fast in the past decade, creating a wide array of new opportunities and clinical applications. Cardiac valves are special entities, with unique characteristics. The technical challenges, the current status and ongoing developments, and future potential clinical a...

Background The long-term pulmonary sequelae of coronavirus disease 2019 (COVID-19) is not well known. Purpose To characterize patterns and rates of improvement of chest CT abnormalities one year after COVID-19 pneumonia. Materials and Methods This was a secondary analysis of a prospective, multicenter observational cohort study conducted fro...

Transaortic (TAo) transcatheter aortic valve implantation has become a valid alternative access route in patients with unsuitable femoral arteries. The current literature does not allow to clearly favor one of the alternative access routes. Every approach has its specific advantages. Transaortic (TAo) access is of particular importance in the case...

This review aims to summarize original articles published in the Journal of Cardiovascular Computed Tomography (JCCT) for the year 2021, focusing on those that had the most scientific and educational impact. The JCCT continues to expand; the number of submissions, published manuscripts, cited articles, article downloads, social media presence, and...

Importance: Distinct plaque locations and vessel geometric features predispose to altered coronary flow hemodynamics. The association between these lesion-level characteristics assessed by coronary computed tomographic angiography (CCTA) and risk of future acute coronary syndrome (ACS) is unknown. Objective: To examine whether CCTA-derived adver...

(1) Background: Whether coronary computed tomography angiography (CTA) or the coronary artery calcium score (CACS) should be used for diagnosis of coronary heart disease, is an open debate. The aim of our study was to compare the atherosclerotic profile by coronary CTA in a young symptomatic high-risk population (age, 19–49 years) in comparison wit...

Aim Obstructive coronary artery disease (CAD) in proximal coronary segments is associated with a poor prognosis. However, the relative importance of plaque location regarding the risk for major adverse cardiovascular events (MACE) in patients with non-obstructive CAD has not been well defined. Methods and results From the Coronary CT Angiography E...

(1) Background: The athlete’s heart may develop permanent vessel enlargement. The purpose of our study was to define normal values for coronary artery dimensions of endurance athletes by coronary computed tomography angiography (CTA). (2) Methods: Ninety-eight individuals (56.2 ± 11 years) were included into this retrospective matched case-controll...

Background Bicuspid aortic valve (BAV) is associated with genetic defects (NOTCH 1, GATA 5 mutations) and aortopathy. Differences in flow pattern and a genetic predisposition could also affect coronary arteries. Purpose To assess the coronary artery calcium score (CACS) and coronary artery disease (CAD) burden by coronary computed tomography angio...

Background Whether the coronary artery calcium score (CACS) or coronary CTA should be used in young high-risk adults for screening of coronary artery disease (CAD), is an open debate and data sparse. Aims To evaluate the coronary atherosclerosis profile by coronary computed tomography angiography (CTA) in a young symptomatic high-risk population (...

Background The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagn...

Objective: Monosodium uric acid (MSU) crystals may accumulate in the coronary plaque. The objective was to assess whether dual-energy computed tomography (DECT) allows for detection of MSU in coronary plaque. Methods: Patients were examined with 128-slice DECT applying a cardiac electrocardiogram-gated and peripheral extremity protocol. Patients...

Introduction Calcific aortic valve disease (CAVD) is caused by an osteoblastic phenotype switch of valvular interstitial cells (VICs), the predominant cell type in heart valves. However, the trigger for the phenotype switch remains unknown. Toll-like receptor 3 (TLR3) is part of the innate immune system activated by viral and endogenous RNA release...

Background: Vitamin D supplementation may be associated with lower cardiovascular (CV) events, but the data are controversial. It remains speculative whether vitamin D supplementation has a direct effect on coronary atherosclerosis. We therefore set out to assess the influence of vitamin D supplementation on the coronary atherosclerosis profile qua...

(1) Background. Bicuspid aortic valve (BAV) is associated with genetic defects (NOTCH 1, GATA 5) and aortopathy. Differences in the flow patterns and a genetic predisposition could also affect coronary arteries. The objective was to assess the coronary artery calcium score (CACS) and coronary artery disease (CAD) burden by coronary computed tomogra...

Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World

Objectives This study sought to evaluate preablation computed tomography angiography (CTA) for atrial and epicardial features to predict atrial fibrillation (AF) recurrence after ablation. Background Structural atrial remodeling is a process associated with occurrence or persistence of AF. Different anatomical imaging features have been proposed t...

Objectives This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardi...

Background: The purpose of this study was to evaluate plantar fasciae of healthy subjects and patients with plantar fasciitis by shear wave velocity (SWV) and stiffness with correlation to B-Mode and color Doppler ultrasonography (CDUS) and to establish cut-off values. Methods: This observational study was conducted with the approval of the Inst...

Aims: Despite the well established role of coronary computed tomography angiography (CCTA) as a diagnostic gatekeeper, the yield of subsequent invasive coronary angiographies (ICA) remains low. We evaluated the adherence of CCTA integration in clinical management and primary prevention therapy. Methods: We retrospectively analyzed patients refer...

Background The AHA recommends statins in patients with CACS>100 AU. However in patients with low CACS (1–99 AU), no clear statement is provided, leaving the clinician in a grey-zone. High-risk plaque (HRP) criteria by coronary CTA are novel imaging biomarkers indicating a higher a-priori cardiovascular (CV) risk, which could help for decision-makin...

Background: The coronary artery calcium score (CACS) is a powerful tool for cardiovascular risk stratification. Coronary computed tomography angiography (CTA) allows for a more distinct analysis of atherosclerosis. The aim of the study was to assess gender differences in the atherosclerosis profile of CTA in patients with a CACS of zero. Methods: A...

Increasing data have accumulated on the role of Cardiac Computed Tomography (CCT) in infective endocarditis (IE) with high accuracy for large vegetations, perivalvular complications and for exclusion of coronary artery disease to avoid invasive angiography. CCT can further help to clarify the etiology of infective prosthetic valve dysfunction (e.g....

The purpose of this review is to highlight the most impactful, educational, and frequently downloaded articles published in the Journal of Cardiovascular Computed Tomography (JCCT) for the year 2020. The JCCT reached new records in 2020 for the number of research submissions, published manuscripts, article downloads and social media impressions. Th...

Objective Pericoronary adipose tissue (PCAT) has been linked to underlying coronary artery disease (CAD) and proposed to modulate adjacent atherosclerotic plaque formation over pro-inflammatory pathways. In vitro and ex vivo studies support the bilateral communication of adipose tissue and vessel wall. We quantified PCAT and its dynamics in a low c...

Background: After the 2002/2003 SARS outbreak, 30% of survivors exhibited persisting structural pulmonary abnormalities. The long-term pulmonary sequelae of coronavirus disease 2019 (COVID-19) are yet unknown, and comprehensive clinical follow-up data are lacking. Methods: In this prospective, multicentre, observational study, we systematically...