Management of thoracic aortic aneurysms (TAAs) comprises regular diameter follow-up until the indication criterion for prophylactic surgery is reached. However, this approach is unable to predict the majority of acute type A aortic dissections (ATAADs). The current study aims to evaluate the diagnostic accuracy of ascending aortic diameter, length and volume for occurrence of ATAAD.This two-centre observational cohort study retrospectively screened 477 consecutive patients who presented with ATAAD between 2009 and 2018. Of those, 25 (5.2%) underwent CT angiography (CTA) within 2 years before dissection onset. Aortic diameter, length and volume of these patients ('pre-ATAAD') were compared with those of TAA controls (n=75). Receiver operating curve analysis was performed to evaluate the predictive accuracy of the three different measurements.96% of patients with pre-ATAAD did not meet the surgical diameter threshold of 55 mm before dissection onset. Maximal aortic diameters (45 (40-49) mm vs 46 (44-49) mm, p=0.075) and volume (126 (95-157) cm3 vs 124 (102-136) cm3, p=0.909) were comparable between patients with pre-ATAAD and TAA controls. Conversely, ascending aortic length (84±9 mm vs 90±16 mm, p=0.031) was significantly larger in patients with pre-ATAAD. All three parameters had an area under the curve of >0.800. At the 55 mm cut-off point, the maximal diameter yielded a positive predictive value (PPV) of 20%. While maintaining same specificity levels, measurements of aortic volume and length showed superior diagnostic accuracy (PPV 55% and 70%, respectively).Measurements of aortic volume and length have superior diagnostic accuracy compared with the maximal diameter and could improve the timely identification of patients at risk for ATAAD.

10.1136/heartjnl-2019-316251

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Growth rates in non-syndromic aneurysms of the ascending aorta: a systematic review

Netherlands Heart Journal (2024)

Luc Cozijnsen Bouke P. Adriaans Tjard Schermer Maarten Groenink Simon Schalla

Abstract The maximum aortic diameter is the main risk predictor for type A acute aortic syndromes and understanding the growth rate of ascending thoracic aortic aneurysms (aTAAs) is pivotal for risk assessment and stratification for pre-emptive aortic surgery. Prevailing guidelines recommend serial imaging of aTAA patients until the thresholds for prophylactic surgery are met. Based on early landmark studies, it was thought that the growth rate of aTAAs is substantially higher than that of the normal-sized aorta. However, more recent studies have reported that aTAA growth is generally slow, questioning the need for frequent imaging during follow-up. The current systematic review provides an overview of studies reporting annual diameter growth rates of non-syndromic aTAAs and explains differences in findings between early and recent studies.

Risk Stratification

Thoracic aorta

Thoracic aortic aneurysm

10.1007/s12471-024-01911-6

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Acute chest pain in the high-sensitivity cardiac troponin era: A changing role for noninvasive imaging?

American Heart Journal (2016)

Martijn W. Smulders Bas Kietselaer Simon Schalla Jan Bucerius Caroline Jaarsma

Management of patients with acute chest pain remains challenging. Cardiac biomarker testing reduces the likelihood of erroneously discharging patients with acute myocardial infarction (AMI). Despite normal contemporary troponins, physicians have still been reluctant to discharge patients without additional testing. Nowadays, the extremely high negative predictive value of current high-sensitivity cardiac troponin (hs-cTn) assays challenges this need. However, the decreased specificity of hs-cTn assays to diagnose AMI poses a new problem as noncoronary diseases (eg, pulmonary embolism, myocarditis, cardiomyopathies, hypertension, renal failure, etc) may also cause elevated hs-cTn levels. Subjecting patients with noncoronary diseases to unnecessary pharmacological therapy or invasive procedures must be prevented. Attempts to improve the positive predictive value to diagnose AMI by defining higher initial cutoff values or dynamic changes over time inherently lower the sensitivity of troponin assays. In this review, we anticipate a potential changing role of noninvasive imaging from ruling out myocardial disease when troponin values are normal toward characterizing myocardial disease when hs-cTn values are (mildly) abnormal.

Myocardial infarction diagnosis

10.1016/j.ahj.2016.03.025

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Adding Speckle-Tracking Echocardiography to Visual Assessment of Systolic Wall Motion Abnormalities Improves the Detection of Myocardial Infarction

Journal of the American Society of Echocardiography (2018)

Manouk J.W. van Mourik Daniëlle V.J. Zaar Martijn W. Smulders Jordi Heijman Joost Lumens

Interquartile range

Speckle tracking echocardiography

Cut-off

10.1016/j.echo.2018.09.007

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Citations (28)

Accentuation of high susceptibility of hypertrophied myocardium to ischemia: Complementary assessment of Gadophrin‐enhancement and left ventricular function with MRI

Magnetic Resonance in Medicine (2004)

Simon Schalla Michael F. Wendland Charles B. Higgins Wolfgang Ebert Maythem Saeed

Abstract The aim of the study was to compare infarction size and left ventricular (LV) function in normal and hypertrophied hearts after brief ischemia using Gadophrin‐enhancement and functional assessment by MRI. Rats (n = 20) were assigned to aortic banding to induce LV hypertrophy or control. Eight weeks later, rats were subjected to 25 min of regional myocardial ischemia followed by 3 hr of reperfusion. The necrosis‐specific agent Gadophrin‐3 was injected to delineate infarcted myocardium on MRI. Effects of aortic banding and ischemia on LV mass and function were determined. At postmortem, areas at risk and infarction were measured. Close correlation was found between LV mass measured with MRI and at postmortem (r = 0.98). LV mass measured with MRI was significantly greater (0.81 ± 0.02 g) in animals with aortic banding compared to control (0.62 ± 0.02 g; P < 0.001). Infarction size was larger in hypertrophied hearts (19.0 ± 1.4% / 18.3 ± 1.5%) than in control (9.8 ± 1.7% / 9.2 ± 2.0%) on Gadophrin‐enhanced MRI and at postmortem, respectively. Similarly, greater impairment in ejection fraction was observed in hypertrophied hearts with MRI (39 ± 4% vs. 49 ± 2%; P = 0.02). Gadophrin‐3 provides accurate estimation of infarct size in hypertrophied hearts. Hypertrophied hearts are more sensitive to ischemia than nonhypertrophied hearts. The complementary assessment of Gadophrin‐enhancement and LV function with MRI provides unique information about myocardium sensitivity to ischemia. Magn Reson Med 51:552–558, 2004. © 2004 Wiley‐Liss, Inc.

10.1002/mrm.20018

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Long-Term Oral Treatment with Nicorandil Prevents the Progression of Left Ventricular Hypertrophy and Preserves Viability

Journal of Cardiovascular Pharmacology (2005)

Simon Schalla Charles B. Higgins Maythem Saeed

Left ventricular (LV) hypertrophy and myocardial infarction play important roles in the progressive LV dysfunction. We hypothesized that the potassium-channel opener and nitrate-like vasodilator nicorandil prevents the development of LV hypertrophy and preserves myocardial viability. Twenty-four rats were subjected to aortic stenosis for 8 weeks to produce LV hypertrophy and assigned to non-treated and nicorandil-treated (3 mg/kg/d) groups. A third group (n = 12) without stenosis or treatment served as control. All 36 animals were subjected to reperfused infarction by 25-minute occlusion of the left coronary artery followed by 3 hours of reperfusion. Spin-echo magnetic resonance (MR) images were acquired to measure infarction size, LV mass, volumes, ejection fraction, and wall thickness. A necrosis-specific contrast agent, Gadophrin-3, was used to delineate necrotic myocardium. Aortic and LV pressures were measured invasively. At postmortem, LV mass and infarction size were determined and compared with MR findings. Nicorandil prevented the development of LV hypertrophy. Infarction size of nicorandil-treated animals was similar to control animals. Non-treated animals with aortic banding had higher LV mass (P < 0.001), lower ejection fraction (P = 0.006), and larger infarction size (P < 0.001) than treated and control animals. MR and postmortem data showed close agreement. Nicorandil therapy prevented the development of cardiac hypertrophy and protected myocardium against ischemia.

Nicorandil

10.1097/01.fjc.0000156824.42833.9a

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Bicuspid Aortic Valve Stenosis and the Effect of Vitamin K2 on Calcification Using 18F-Sodium Fluoride Positron Emission Tomography/Magnetic Resonance: The BASIK2 Rationale and Trial Design

Nutrients (2018)

Frederique E.C.M. Peeters Manouk van Mourik Steven J.R. Meex Jan Bucerius Simon Schalla

BASIK2 is a prospective, double-blind, randomized placebo-controlled trial investigating the effect of vitamin K2 (menaquinone-7;MK7) on imaging measurements of calcification in the bicuspid aortic valve (BAV) and calcific aortic valve stenosis (CAVS). BAV is associated with early development of CAVS. Pathophysiologic mechanisms are incompletely defined, and the only treatment available is valve replacement upon progression to severe symptomatic stenosis. Matrix Gla protein (MGP) inactivity is suggested to be involved in progression. Being a vitamin K dependent protein, supplementation with MK7 is a pharmacological option for activating MGP and intervening in the progression of CAVS. Forty-four subjects with BAV and mild-moderate CAVS will be included in the study, and baseline

Sodium fluoride

10.3390/nu10040386

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Magnetic resonance flow measurements in real time: Comparison with a standard gradient‐echo technique

Journal of Magnetic Resonance Imaging (2001)

Christoph Klein Simon Schalla Bernhard Schnackenburg Axel Bornstedt Eckart Fleck

Abstract Ultrafast gradient systems and hybrid imaging sequences offer the opportunity to acquire phase contrast flow data in real time. In a 1.5‐Tesla magnetic resonance (MR)‐tomograph, peak velocity and volume flow were assessed in 36 large vessels (aorta) and 33 medium‐sized vessels (carotid and iliac artery) using a real‐time (segmented k‐space turbo gradient‐echo planar imaging sequence) in comparison with a gradient‐echo technique. With the real‐time technique, the matrix was reduced from 116 to 64, and temporal resolution changed from 30 msec to 124 msec. Measurements of peak velocity correlated in large (r = 0.88) and medium‐sized vessels (r = 0.81). Volume flow measurements correlated in large vessels (r = 0.87), however, a poor correlation (r = 0.64) was found in medium‐sized vessels. Thus, scan time can be significantly reduced and images acquired without electrocardiogram (ECG)‐triggering. Flow volume can only be determined in large vessels with sufficient accuracy, mainly due to reduced spatial resolution in smaller vessels.J. Magn. Reson. Imaging 2001;14:306–310. © 2001 Wiley‐Liss, Inc.

Temporal resolution

Echo-planar imaging

10.1002/jmri.1187

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Citations (23)