Try a new search

Format these results:

Searched for:



Total Results:


Usefulness of cardiac computed tomographic delayed contrast enhancement of the left atrial appendage before pulmonary vein ablation

Sawit, Simonette T; Garcia-Alvarez, Ana; Suri, Bhavna; Gaztanaga, Juan; Fernandez-Friera, Leticia; Mirelis, Jesus G; D'Anca, Michael; Fuster, Valentin; Sanz, Javier; Garcia, Mario J
Left atrial appendage (LAA) contrast filling defects are commonly found in patients undergoing multidetector cardiac computed tomography (CCT) before catheter ablation of atrial fibrillation. Delayed CCT allows quantification of the LAA delayed/initial attenuation ratio and improves accuracy for LAA thrombus detection, which may obviate routine transesophageal echocardiography (TEE) before ablation. CCT with contrast-enhanced scans (initial CCT) and with noncontrast-enhanced scans (delayed CCT) was performed in 176 patients. LAA was evaluated for filling defects. LAA apex, left atrial (LA) body, and ascending aorta (AA) attenuations (Hounsfield units) were measured on initial and delayed cardiac computed tomograms to calculate LAA, LA, LAA/LA, and LAA/AA attenuation ratios. LAA, initial LAA/LA, and initial LAA/AA attenuation ratios differed significantly in patients with versus without filling defects on cardiac computed tomogram, those with atrial fibrillation versus normal sinus rhythm, and those with abnormal left ventricular ejection fraction versus larger LA volumes (p <0.05). In 70 patients (40%) who underwent TEE, 13 LAA filling defects were seen on initial cardiac computed tomogram. Two defects persisted on delayed cardiac computed tomogram and thrombus was confirmed on transesophageal echocardiogram. Sensitivity, specificity, and positive and negative predictive values of initial CCT for LAA thrombi detection were 100%, 84%, 15%, and 100%, respectively. With delayed CCT these values increased to 100%. Intraobserver and interobserver reproducibilities for cardiac computed tomographic measurements were good (intraclass correlation 0.72 to 0.97, kappa coefficients 0.93 to 1.00). In conclusion, delayed CCT provided an increase in diagnostic accuracy of CCT for detection of LAA thrombus in patients with atrial fibrillation before ablation, which may decrease the need for routine TEE before the procedure.
PMID: 22364703
ISSN: 1879-1913
CID: 2724012

Cardiac computed tomography delayed contrast enhancement of the left atrial appendage prior to pulmonary vein ablation: is routine transesophageal echocardiography avoidable? [Meeting Abstract]

Sawit, S; Garcia-Alvarez, A; Suri, B; Gaztanaga, J; Fernandez-Friera, L; Mirelis, JGonzalez; D'anca, M; Fuster, V; Sanz, J; Garcia, MJ
ISSN: 0195-668x
CID: 2724072

Hormonal influences on women with psoriasis

Mowad, C M; Margolis, D J; Halpern, A C; Suri, B; Synnestvedt, M; Guzzo, C A
Various endogenous factors such as stress and infection are known to influence psoriasis. Previous data suggest that pregnancy has a significant influence on the course of psoriasis. This study explores the effect of pregnancy as well as other hormonal events on psoriasis in women.
PMID: 9608337
ISSN: 0011-4162
CID: 2724022