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Anomalous right coronary artery originating from the opposite sinus of Valsalva: Fractional flow reserve and intravascular ultrasound-guided management [Case Report]

Singh, Arushi; Donnino, Robert; Small, Adam; Bangalore, Sripal
There remains significant controversy in the risk stratification and management of patients with anomalous right coronary artery originating from the opposite sinus (R-ACAOS). We present the case of a patient with an inferior ST-elevation myocardial infarction, found to have R-ACAOS and severe atherosclerotic right coronary artery disease, treated with fractional flow reserve and intravascular ultrasound-guided percutaneous coronary intervention.
PMID: 37724846
ISSN: 1522-726x
CID: 5609442

Existing Nongated CT Coronary Calcium Predicts Operative Risk in Patients Undergoing Noncardiac Surgeries (ENCORES)

Choi, Daniel Y; Hayes, Dena; Maidman, Samuel D; Dhaduk, Nehal; Jacobs, Jill E; Shmukler, Anna; Berger, Jeffrey S; Cuff, Germaine; Rehe, David; Lee, Mitchell; Donnino, Robert; Smilowitz, Nathaniel R
BACKGROUND:Preoperative cardiovascular risk stratification before noncardiac surgery is a common clinical challenge. Coronary artery calcium scores from ECG-gated chest computed tomography (CT) imaging are associated with perioperative events. At the time of preoperative evaluation, many patients will not have had ECG-gated CT imaging, but will have had nongated chest CT studies performed for a variety of noncardiac indications. We evaluated relationships between coronary calcium severity estimated from previous nongated chest CT imaging and perioperative major clinical events (MCE) after noncardiac surgery. METHODS:We retrospectively identified consecutive adults age ≥45 years who underwent in-hospital, major noncardiac surgery from 2016 to 2020 at a large academic health system composed of 4 acute care centers. All patients had nongated (contrast or noncontrast) chest CT imaging performed within 1 year before surgery. Coronary calcium in each vessel was retrospectively graded from absent to severe using a 0 to 3 scale (absent, mild, moderate, severe) by physicians blinded to clinical data. The estimated coronary calcium burden (ECCB) was computed as the sum of scores for each coronary artery (0 to 9 scale). A Revised Cardiac Risk Index was calculated for each patient. Perioperative MCE was defined as all-cause death or myocardial infarction within 30 days of surgery. RESULTS:<0.0001). An ECCB ≥3 was associated with 2-fold higher adjusted odds of MCE versus an ECCB <3 (adjusted odds ratio, 2.11 [95% CI, 1.42-3.12]). CONCLUSIONS:Prevalence and severity of coronary calcium obtained from existing nongated chest CT imaging improve preoperative clinical risk stratification before noncardiac surgery.
PMID: 37732454
ISSN: 1524-4539
CID: 5599072

Nonischemic Cardiomyopathy With Myocardial Calcinosis Masquerading as Cardiac Amyloidosis

Singh, Arushi; Kadosh, Bernard S; Grossman, Kelsey; Donnino, Robert; Narula, Navneet; Zhou, Fang; DiVita, Michael; Smith, Deane E; Moazami, Nader; Chang, Stephanie H; Angel, Luis F; Reyentovich, Alex
PMID: 37492988
ISSN: 1941-3297
CID: 5620132

Concordance of Pericardial Effusion Size Between Computed Tomography and Echocardiography

Zhang, Robert S; Alter, Eric; Kozloff, Samuel; Choy-Shan, Alana; Xia, Yuhe; Patel, Kunal; Gozansky, Elliott K; Saric, Muhamed; Stojanovska, Jadranka; Donnino, Robert
Discrepancy between computed tomography (CT) and transthoracic echocardiography (TTE) regarding pericardial effusion (PEff) size is common, but there is limited data regarding the correlation between these 2 imaging methods. The aim of this study is to examine the real-world concordance of observed PEff size between CT and TTE. We performed a retrospective analysis of all imaging reports available from 2013 to 2019 and identified patients with a PEff who underwent both a chest CT and TTE within a 24-hour period. We evaluated the agreement between CT and TTE in assessing PEff size. Of 1,118 patients included in the study, mean age was 66 (±17 years) and 54% were female. The median time interval between the 2 studies was 9.4 hours (interquartile range 3.5 to 16.6). Patients within a half-grade or full-grade of agreement were 71.9% and 97.2%, respectively. The mean difference in grade of agreement (TTE minus CT) between the 2 imaging methods was -0.1 (±0.6, p <0.0001). CT was more likely to report a higher grade (i.e. larger PEff size) when compared with TTE (261 patients vs 157 patients, p <0.001). The weighted kappa was 0.73 (95% confidence interval 0.69 to 0.76). After excluding patients with trace/no effusion, 42.3% and 94.1% of patients' studies were within a half-grade or full-grade of agreement, respectively. Of the 18 patients who had large discrepancies, 9 patients had loculated effusions, 2 patients had large pleural effusions, and 6 patients had suboptimal TTEs images. In conclusion, TTE and CT showed relatively strong agreement in estimation of PEff size, with CT sizes larger than TTE, on average. Large discrepancies in size may be related to reduced image quality, large pleural effusions, and loculated PEff.
PMID: 37487407
ISSN: 1879-1913
CID: 5606862

Isolated Left Ventricular Apical Hypoplasia: A Very Rare Congenital Anomaly Characterized by Multimodality Imaging and Invasive Testing

Maidman, Samuel D; Salerno, William D; Halpern, Dan G; Donnino, Robert; Saric, Muhamed
PMID: 36448445
ISSN: 1942-0080
CID: 5373972

Multimodality Imaging of Caval and Coronary Sinus Venous Anomalies [Case Report]

Liebman, Jordan; Bamira, Daniel; Ro, Richard; Vainrib, Alan F; Small, Adam J; Donnino, Robert; Saric, Muhamed
PMID: 36247374
ISSN: 2468-6441
CID: 5356652

A Novel Index of Coronary Artery Calcium Derived From Preoperative Non-Gated Chest Computed Tomography Correlates With Traditional Estimates of Perioperative Risk [Meeting Abstract]

Maidman, Samuel D.; Choi, Daniel; Hayes, Dena; Dhaduk, Nehal; Donnino, Robert; Smilowitz, Nathaniel R.
ISSN: 0009-7322
CID: 5522552

Correlations Between Coronary Artery Calcium From Non-Gated Computed Tomography and Conventional Estimates of Peri-Operative Risk by Age and Sex [Meeting Abstract]

Hayes, Dena; Choi, Daniel; Maidman, Samuel D.; Dhaduk, Nehal; Donnino, Robert; Smilowitz, Nathaniel R.
ISSN: 0009-7322
CID: 5522562

Inter-Reader Reliability of Coronary Calcium Estimation From Non-Gated Chest Computed Tomography Scans Using a Semi-Quantitative Scoring Method [Meeting Abstract]

Dhaduk, Nehal; Choi, Daniel; Maidman, Samuel; Hayes, Dena; Smilowitz, Nathaniel; Donnino, Robert
ISSN: 0009-7322
CID: 5522572

Multimodality Imaging of Myocardial Viability

Parikh, Kinjan; Choy-Shan, Alana; Ghesani, Munir; Donnino, Robert
PURPOSE OF REVIEW/OBJECTIVE:Myocardial viability is an important pathophysiologic concept which may have significant clinical impact in patients with left ventricular dysfunction due to ischemic heart disease. Understanding the imaging modalities used to assess viability, and the clinical implication of their findings, is critical for clinical decision-making in this population. RECENT FINDINGS/RESULTS:The ability of dobutamine echocardiography, single-photon emission computed tomography, positron emission tomography, and cardiac magnetic resonance imaging to predict functional recovery following revascularization is well-established. Despite different advantages and disadvantages for each imaging modality, each modality has demonstrated reasonable performance characteristics in identifying viable myocardium. Recent data, however, has called into question whether this functional recovery leads to improved clinical outcomes. Although the assessment of viability can be used to aid in clinical decision-making prior to revascularization, its broad application to all patients is limited by a lack of data confirming improvement in clinical outcomes. Thus, viability assessments may be best applied to select patients (such as those with increased surgical risk) and integrated with clinical, laboratory, and imaging data to guide clinical care. Future research efforts should be aimed at establishing the impact of viability on clinical outcomes.
PMID: 33398512
ISSN: 1534-3170
CID: 4759312