Try a new search

Format these results:

Searched for:

person:karlsd01

in-biosketch:true

Total Results:

7


Going beyond the coronaries: Routine cardiovascular risk assessment reveals rare incidental thymoma [Case Report]

Karlsberg, Daniel; Steyer, Henry; Grignoli, Nicole; Rumberger, John
Thymomas are rare anterior mediastinal masses that present with local or paraneoplastic symptoms. Definitive diagnosis requires tissue sampling but early detection leads to early intervention and improved outcomes. We present a case where routine cardiovascular risk assessment identified an incidental and rare thymoma. Final specimen pathology revealed a Thymoma WHO Type AB (30% A, 70% B). Routine cardiovascular risk assessment which often includes coronary artery calcium scanning and cardiovascular computed tomographic angiography may reveal pathology beyond the coronary arteries. Early detection of asymptomatic mediastinal masses facilitates early intervention and can improve outcomes.
PMCID:9932289
PMID: 36816335
ISSN: 1930-0433
CID: 5443552

Radiation reduction with prospective ECG-triggering acquisition using 64-multidetector Computed Tomographic angiography

Gopal, Ambarish; Mao, Song S; Karlsberg, Daniel; Young, Emily; Waggoner, Joshua; Ahmadi, Naser; Pal, Raveen S; Leal, John; Karlsberg, Ronald P; Budoff, Matthew J
Current 64-multidetector Computed Tomographic scanners (MDCT) utilize retrospective overlapping helical acquisition (RS-OHA) which imparts a higher than desired radiation dose. Although the radiation burden of computed tomographic angiography (CTA) can be efficiently reduced by dose modulation and limiting field of view, a further decrease in radiation without compromising diagnostic image quality would be indeed very desirable. An alternative imaging mode is the axial prospective ECG-triggering acquisition (prospective gating). This study was done to compare the effective radiation dose and the image quality with two techniques to reduce radiation doses with CTA studies utilizing 64-MDCT scanners. The study included 149 consecutive patients (48 females and 101 males) 64-MDCT (mean age = 67 +/- 11 years, 72.2% male). Patients underwent CT coronary angiography using one of three algorithms: retrospective triggering with dose modulation; prospective triggering with padding (step and shoot acquisition with additional adjacent phases); and prospective triggering without padding (single phase acquisition only). Based on body habitus, two different voltages were utilized: 100 kVp (<85 kg) or 120 kVp (>85 kg). Radiation doses and image quality (signal to noise ratio) was measured for each patient, and compared between different acquisition protocols. The signal to-noise ratio of the ascending aorta (SNR-AA) was calculated from the mean pixel values of the contrast-filled left ventricular chamber divided by the standard deviation of these pixel values. Use of 100 kVp reduced radiation dose 41.5% using prospective triggering and 39.6% using retrospective imaging as compared to 120 kVp (P < 0.001). Use of prospective imaging reduced radiation exposure by 82.6% as compared to retrospective imaging (P < 0.001). Using both prospective imaging and 100 kVp without padding (single phase data, no other phases obtained), radiation dose was reduced by 90% (P < 0.001). In terms of image quality, the coefficient of variation of ascending aortic contrast enhancement between kVp of 120 and kVp of 100 was 6% (1.05, 95 CI 0.93-1.17), and 7.8% (0.9, 95% CI 0.7-1.2) at the pulmonary artery. The prospective ECG-Triggered acquisition and 100 kVp images were of diagnostic quality, allowing adequate assessment in all patients. CTA using PA and 100 kVp reduced the radiation dose by up to 90% without compromising the image quality.
PMID: 19051055
ISSN: 1875-8312
CID: 4799142

426 Impact Of Visceral Abdominal Tissue On Coronary Artery Disease As Defined By Quantitative Computed Tomographic Angiography [Meeting Abstract]

Karlsberg, D; Steyer, H; Fisher, R; Crabtree, T; Min, J; Earls, J; Rumberger, J
Introduction: Obesity has long been associated with all-cause mortality and cardiovascular disease (CVD). Visceral abdominal tissue (VAT) has been proposed as an important CVD risk stratification metric given its independent correlation with myocardial infarction and stroke. This study aims to clarify the relationship between the presence and severity of VAT with the presence and severity of coronary artery plaque as defined by total plaque volume, calcified plaque volume, non-calcified plaque volume, and high risk low-density non-calcified plaque using quantitative coronary computed tomography atherosclerosis imaging (AI-QCT).
Method(s): CCTA was performed using single or dual source CT scanners of >64-detector rows. Coronary atherosclerosis evaluation by CCTA (AI-QCT) was performed. The AI-based approach to CCTA interpretation in this study was performed using an FDA-cleared software service (Cleerly Lab, Cleerly, New York, NY) that performs automated analysis of CCTA using a series of validated convolutional neural network models (including VGG19 network, 3D U-Net, and VGG Network Variant) for image quality assessment, coronary segmentation and labeling, lumen wall evaluation and vessel contour determination and plaque characterization. Coronary segments with a diameter >1.5 mm were included in the analysis using the modified 18-segment SCCT model. Plaque volume was categorized using Hounsfield unit (HU) ranges, with LD-NCP defined as plaques <30 HU, NCP defined as HU between -30 and +350, and CP defined as >350 HU12,13.
Result(s): The study cohort was comprised of 145 patients, 56.1 +/- 8.5 years, 84.0% male. Overall, 3.5% had a history of diabetes, 19% hypertension, 38% dyslipidemia, 8% current smokers, and 34% had a family history of CAD. At the time of the examination, 37% were taking statins, 21% anti-hypertension medications, and 11% non-stating lipid lowering medication. There was a stepwise progression of the median coronary plaque volume for each quartile of visceral fat including TPV (Q1: 19.8, Q2: 48.1, Q3: 86.4, and Q4: 136.6 mm3 (P=0.0098)), NCP (Q1: 15.7, Q2: 35.4, Q3: 86.4, and Q4: 136.6 mm3 (P=0.0032)) and LD-NCP (Q1: 0.6, Q2: 0.81, Q3: 2.0, and Q4: 5.0 mm3 (P<0.0001)). There was also a stepwise progression of the median maximum diameter stenosis for each quartile of visceral fat (Q1: 18.0, Q2: 27.0, Q3: 27.5, and Q4: 29.5% (P=0.0414)) as well as medial coronary plaque length (Q1: 12.8, Q2: 19.5, Q3: 26.4, and Q4: 27.5mm (P=0.0077))
Conclusion(s): Our findings represent the first demonstration of a stepwise progression with regards to visceral abdominal tissue and total plaque volume, non-calcified plaque volume, and low density non-calcified plaque volume. This relationship is particularly striking with regards to the progression and severity of VAT and the presence and amount of low density non-calcified plaque, which is known to be high risk for cardiovascular events.
Copyright
EMBASE:2019317971
ISSN: 1876-861x
CID: 5291842

Impact of visceral fat on coronary artery disease as defined by quantitative computed tomography angiography

Karlsberg, Daniel; Steyer, Henry; Fisher, Rebecca; Crabtree, Tami; Min, James K; Earls, James P; Rumberger, John
OBJECTIVE:Obesity is associated with all-cause mortality and cardiovascular disease (CVD). Visceral fat (VF) is an important CVD risk metric given its independent correlation with myocardial infarction and stroke. This study aims to clarify the relationship between the presence and severity of VF with the presence and severity of coronary artery plaque. METHODS:In 145 consecutive asymptomatic patients, atherosclerosis imaging-quantitative computed tomography was performed for total plaque volume (TPV) and percentage atheroma volume, as well as the volume of noncalcified plaque (NCP), calcified plaque, and low-density NCP (LD-NCP), diameter stenosis, and vascular remodeling. This study also included VF analysis and subcutaneous fat analysis, recording of outer waist circumference, and percentage body fat analysis. RESULTS:[p < 0.0001]). CONCLUSIONS:These findings demonstrate progression with regard to VF and TPV, NCP volume, and LD-NCP volume. Notably, there was a progression of VF and amount of LD-NCP, which is known to be high risk for future cardiovascular events. A consistent progression may indicate the future utility of VF in CVD risk stratification.
PMID: 37559558
ISSN: 1930-739x
CID: 5619092

BACTERIAL ENDOCARDITIS IN A PATIENT WITH REPAIRED TETRALOGY OF FALLOT: A RARE CASE OF A HOMOGRAFT RIGHT VENTRICLE TO PULMONARY ARTERY CONDUIT ACUTE OBSTRUCTION [Meeting Abstract]

Alishetti, Shudhanshu; Karlsberg, Daniel; Nam Tran; Milechman, Gary; Egrie, Glenn
ISI:000397342303151
ISSN: 0735-1097
CID: 4799172

Anonymity: an impediment to performance in healthcare

Karlsberg, Daniel W; Pierce, Read G
Many teaching hospitals employ a care team structure composed of a broad range of healthcare providers with different skill sets. Each member of this team has a distinct role and a different level of training ranging from attending physician to resident, intern, and medical student. Often times, these different roles lead to greater complexity and confusion for both patients and nursing staff. It has been demonstrated that patients have a great degree of difficulty in identifying members of their care team. This anonymity also exists between nursing staff and other care providers. In order to better understand the magnitude of anonymity within the teaching hospital, a ten-question survey was sent to nurses across three different departments. Results from this survey demonstrated that 71% of nurses are "Always" or "Often" able to identify which care team is responsible for their patients, while 79% of nurses reported that they either "Often" or "Sometimes" page a provider who is not currently caring for a given patient. Furthermore, 33% of nurses felt that they were either "Rarely" or "Never" able to recognize, by face and name, attending level providers. Residents were "Rarely" or "Never" recognized by face and name 37% of the time, and interns 42% of the time. Contacting the wrong provider repeatedly leads to de facto delays in medication, therapy, and diagnosis. Additionally, these unnecessary interruptions slow workflow for both nurses and members of the care team, making hospital care less efficient and safe overall. Technological systems should focus on reducing anonymity within the hospital in order to enhance healthcare delivery.
PMCID:4122533
PMID: 25114570
ISSN: 1178-6329
CID: 4799162

Quadricuspid aortic valve defined by echocardiography and cardiac computed tomography [Case Report]

Karlsberg, Daniel W; Elad, Yaron; Kass, Robert M; Karlsberg, Ronald P
A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency. Echocardiography showed severe aortic regurgitation and a probable quadricuspid aortic valve. In anticipation of aortic valve replacement, cardiac computed tomography (Cardiac CT) was performed using 100 kV, 420 mA which resulted in 6 mSv of radiation exposure. Advanced computing algorithmic software was performed with a non-linear interpolation to estimate potential physiological movement. Surgical photographs and in-vitro anatomic pathology exam reveal the accuracy and precision that preoperative Cardiac CT provided in this rare case of a quadricuspid aortic valve. While there have been isolated reports of quadricuspid diagnosis with Cardiac CT, we report the correlation between echocardiography, Cardiac CT, and similar appearance at surgery with confirmed pathology and interesting post-processed rendered images. Cardiac CT may be an alternative to invasive coronary angiography for non-coronary cardiothoracic surgery with the advantage of providing detailed morphological dynamic imaging and the ability to define the coronary arteries non-invasively. The reduced noise and striking depiction of the valve motion with advanced algorithms will require validation studies to determine its role.
PMCID:3303489
PMID: 22442640
ISSN: 1179-5468
CID: 4799152