Journal Article Corrected proof Left ventricle outflow tract obstruction after transcatheter mitral valve replacement with a transatrial approach Get access Juan M Farina, Juan M Farina Department of Cardiovascular Diseases, Mayo Clinic, 13400 E Shea Blvd, Phoenix, AZ 85259, USA https://orcid.org/0000-0002-5824-8485 Search for other works by this author on: Oxford Academic PubMed Google Scholar Clinton E Jokerst, Clinton E Jokerst Department of Radiology, Mayo Clinic, Phoenix, AZ, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Susan Wilansky, Susan Wilansky Department of Cardiovascular Diseases, Mayo Clinic, 13400 E Shea Blvd, Phoenix, AZ 85259, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Reza Arsanjani, Reza Arsanjani Department of Cardiovascular Diseases, Mayo Clinic, 13400 E Shea Blvd, Phoenix, AZ 85259, USA Corresponding author. E-mail: arsanjani.reza@mayo.edu https://orcid.org/0000-0001-7081-4286 Search for other works by this author on: Oxford Academic PubMed Google Scholar Kristen A Sell-Dottin Kristen A Sell-Dottin Department of Cardiothoracic Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal - Cardiovascular Imaging, jead279, https://doi.org/10.1093/ehjci/jead279 Published: 24 October 2023 Article history Published: 24 October 2023 Corrected and typeset: 03 November 2023
Background Combined assessment of wall motion from cine imaging and perfusion defects from first-pass perfusion (FPP) imaging has been shown to have a high diagnostic performance for detection of acute ischemia. In this setting, a single ungated CMR scan capable of simultaneously capturing perfusion deficits and wall motion abnormality can be useful for rapid diagnosis of ongoing acute ischemia. We propose an accelerated FPP technique with ungated continuous acquisition capable of generating cardiacphase resolved FPP images thereby enabling concurrent imaging of wall motion and perfusion deficits.
Abstract Aims Current non-invasive screening methods for cardiac allograft rejection have shown limited discrimination and are yet to be broadly integrated into heart transplant care. Given electrocardiogram (ECG) changes have been reported with severe cardiac allograft rejection, this study aimed to develop a deep-learning model, a form of artificial intelligence, to detect allograft rejection using the 12-lead ECG (AI-ECG). Methods and results Heart transplant recipients were identified across three Mayo Clinic sites between 1998 and 2021. Twelve-lead digital ECG data and endomyocardial biopsy results were extracted from medical records. Allograft rejection was defined as moderate or severe acute cellular rejection (ACR) based on International Society for Heart and Lung Transplantation guidelines. The extracted data (7590 unique ECG-biopsy pairs, belonging to 1427 patients) was partitioned into training (80%), validation (10%), and test sets (10%) such that each patient was included in only one partition. Model performance metrics were based on the test set (n = 140 patients; 758 ECG-biopsy pairs). The AI-ECG detected ACR with an area under the receiver operating curve (AUC) of 0.84 [95% confidence interval (CI): 0.78–0.90] and 95% (19/20; 95% CI: 75–100%) sensitivity. A prospective proof-of-concept screening study (n = 56; 97 ECG-biopsy pairs) showed the AI-ECG detected ACR with AUC = 0.78 (95% CI: 0.61–0.96) and 100% (2/2; 95% CI: 16–100%) sensitivity. Conclusion An AI-ECG model is effective for detection of moderate-to-severe ACR in heart transplant recipients. Our findings could improve transplant care by providing a rapid, non-invasive, and potentially remote screening option for cardiac allograft function.
Introduction: The right ventricle (RV) strain measured by speckle tracking (RVS) is a novel method of assessing RV function. We compared RVS to RV fractional area change (FAC%), tricuspid annular peak systolic excursion (TAPSE) and Doppler tissue imaging-derived peak systolic velocity (S’) in the assessment of right ventricular (RV) systolic function measured using cardiac magnetic resonance imaging (MRI). Methods: We enrolled consecutive patients who underwent cardiac MRI between Jan 2012- Dec 2017 and a transthoracic echocardiogram (TTE) within 1 month of the MRI with no interval event. Baseline clinical characteristics and MRI parameters were extracted from chart review. Echocardiographic parameters were measured prospectively. TTE parameters including RVS, TAPSE, S’ and FAC% were tested for accuracy to identify impaired RV EF (EF <45% & <30%) using receiver operator curves. Results: The study cohort included 500 patients with mean age 55 yr ± 18 and right ventricular systolic pressure 33.7 ± 13.6 mmHg. The area under ROC for RVS was 0.69 (95% CI 0.63 – 0.75) and 0.78 (95% CI 0.70 – 0.88) to predict RVEF <45% & RVEF <30% respectively. The RV FAC % had second highest accuracy of predicting RVEF among all the TTE parameters tested in study. Conclusion: Right ventricular strain is the most accurate echocardiographic method to detect impaired right ventricular systolic function when using MRI as the gold standard.
Full therapeutic heparin doses ranging from 5000-10,000 units or weight based (70-100 units/kg) have been recommended during percutaneous coronary interventions. However, there are currently no data available in regards to the appropriate dosing of unfractionated heparin during intravascular ultrasound (IVUS) studies without therapeutic coronary interventions. The goal of this study was to evaluate the safety of low dose unfractionated heparin during IVUS studies, shortly after endomyocardial biopsy in cardiac transplant patients.At the University of Arizona Medical Center, transplant patients routinely undergo diagnostic IVUS studies for the detection of early cardiac allograft vasculopathy (CAV) shortly after endomyocardial biopsy. A low-dose heparin (2000 to 3000 Units) is given before coronary wire and IVUS catheter advancement without checking activated clotting time. We evaluated the occurrence of any thromboembolic event or any other adverse outcomes in this population.A total of 108 cardiac transplant patients, who had underwent routine IVUS studies between 2004-2008 were identified retrospectively. The average heparin dose used was 2528 ± 501 units. The left anterior descending artery was studied in 93% of cases. There was no thromboembolic event. Only one catheter-induced coronary dissection occurred treated with percutaneous coronary intervention. An endomyocardial biopsy was performed 10-15 minutes before the administration of low-dose heparin. There were no other major adverse cardiac events in this population during the procedure.This is the first study showing the safety of low-dose heparin use during diagnostic IVUS studies in cardiac transplant patients, even shortly after endomyocardial biopsy.
