Thoracic endovascular aortic repair (TEVAR) is one of the main treatments, together with open aortic repair, for thoracic aortic aneurysm. This procedure is associated with low procedural morbidity and mortality and provides satisfactory mid-term results. However, identifying the optimal location for device deployment before the operation remains essential. In previous studies, computer simulations were used to examine the hemodynamic stress linked to different areas of the arch, pinpointing regions unsuitable for TEVAR delivery. Computational fluid dynamics (CFD) simulations suggest that zone 3 poses the most challenges for delivering endograft in type III arches, as it is considered a hostile region from biomechanical and hemodynamic perspectives. Morphologically, type III aortic arch shows a more pronounced curvature and a lower position of the arch, resulting in increased separation between the ascending and descending aorta. However, these studies utilized 3D geometrical models reconstructed from computed tomography angiography scans. Still, the flow boundary conditions were based on existing data rather than the specific hemodynamic characteristics of the patient. To bridge this gap, the present study uses MRI flow wave data to compute displacement forces (DFs) for each proximal landing zone. We found that zones 0 and 3 exhibited a high magnitude of displacement forces. Still, only zone 3 was identified as the most hemodynamically stressed area when the force was normalized for the lumen area. Furthermore, there was a significant discontinuity in the upward components of DFs between zone 2 and zone 3. The patient-specific assessment of displacement forces enabled us to identify suboptimal areas for TEVAR delivery, suggesting that personalized computer simulations could greatly enhance preoperative planning for TEVAR procedures.

The main objective was to assess the geographical distribution and main areas of use of dual-energy CT (DECT) scanners in Italy prior to the implementation of the National Recovery and Resilience Plan (NRRP) within the Next Generation EU (NGEU) framework. Secondary objectives included the level of knowledge of DECT among radiologists and some possible solutions to maximize its use. Between February and March 2022, an anonymous questionnaire was conducted among the members of the Italian Society of Medical and Interventional Radiology (SIRM), using the Google form platform. A total of 261 radiologists (mean age 41 ± 11.7 years) from 90 Italian cities participated in the questionnaire. 42

PURPOSE:The study aim is to assess how surgical or endovascular treatments can impact carotid perivascular inflammation in patients affected by severe carotid artery stenosis. METHODS:Seventy consecutive patients with unilateral carotid stenosis from the BAROX trial were included in this study. CT angiography (CTA) exams were conducted on a dual-source CT system before and after the carotid endarterectomy (CEA) or stenting. Perivascular adipose tissue (PVAT) CT attenuation measurement in a 40 mm proximal segment of the internal carotid artery was measured as carotid PVAT (CPVAT). CT attenuation was calculated as the mean attenuation of all voxels in the range of -30 to -190 HU, thresholds used for identifying adipose tissue. RESULTS:The median CPVAT measurements before and after both surgical and percutaneous procedures in the stenotic side was -60 (-66, -57) before and -61 (-66, -56) after procedure (p = 0.046). The median CPVAT measurements before and after the surgical procedures was -59 (-66, -57) before and -59 (-62, -54) after procedure (p = 0.006). As well as before- and after stent placement was -60 (-65, -55) before and -65 (-70, -60) after procedure (p = 0.103). A correlation analysis showed a positive correlation between post-procedure CPVAT and the occurrence of the procedure (ρ = 0.403, p = 0.003), as well as a positive correlation between pre- and post-procedure CPVAT on the untreated side and the degree of stenosis (pre-procedure: ρ = 0.328, p = 0.007; post-procedure: ρ = 0.271, p = 0.027). CONCLUSION:We found an increase in CPVAT following CEA, indicating that an inflammatory process occurs during treatment.

Background: Marfan syndrome (MFS) is a rare autosomal dominant disorder affecting connective tissues due to mutations in the fibrillin-1 gene. These genetic changes often result in severe cardiovascular conditions, including asymptomatic thoracic aortic dilation potentially leading to dissection or rupture. Perivascular adipose tissue attenuation (PVAT) observed on computed tomography may serve as a marker of localized inflammation and indicate early histopathological changes in the vascular walls of MFS patients compared to healthy individuals. Objective: This study aimed to compare PVAT values between patients with MFS and healthy controls in order to explore whether MFS patients show higher PVAT secondary to these histopathological abnormalities. Methods: This case–control study assessed PVAT on ascending aorta through computed tomography angiography (CTA) in 54 genetically confirmed MFS patients and 43 controls with low ischemic risk, excluding those with known aortic aneurysms. Results: PVAT analysis revealed significant differences between the MFS patients and healthy controls (−70.6 HU [−72.6 HU to −68.5 HU] versus −75.1 HU [−77.1 HU to −73.1 HU], p = 0.002), suggesting potential early vascular changes in the MFS group. Conclusions: The findings underscore the potential diagnostic role of PVAT in patients with genetically confirmed MFS but normal ascending aorta diameter.

Biomechanical analysis of crosstalk between the carotids remains poorly underexplored. This study aims to clarify the impact of severe carotid stenosis on the local hemodynamics of the opposite carotid artery, before and after treatment. Data from patients diagnosed with severe internal carotid artery stenosis (≥ 70%), treated with carotid artery stenting (CAS) or carotid endarterectomy (CEA) were analyzed. Both sides' anatomical and hemodynamic remodeling parameters were evaluated before and after treatment. Forty-two patients underwent computed tomography angiography (CTA) and phase-contrast magnetic resonance imaging (PC-MRI) to measure carotid diameters and flow rates in the common, internal, and external carotids (CCA, ICA, and ECA, respectively) before and after CAS or CEA. Additionally, patient-specific computational fluid dynamics (CFD) simulations were performed to calculate time-averaged wall shear stress (taWSS) before and after the treatment. Post-treatment analysis revealed anatomical and hemodynamic changes in the contralateral side. Specifically, there was a decrease in blood flow and an increase in vessel diameters, particularly in the CCA, of patients who had undergone CEA (pre vs. post: flow p = .029, diameter p = .007). Additionally, there was an increase in low taWSS areas in the SOI after the operation: CEA from 15.50 (10.80) % to 18.00 (20.25) %, CAS from 17.00 (15.55) % to 19.50 (20.50) %. The study revealed new anatomical and hemodynamic parameters changes in both carotids, offering insights into the interaction between stenotic and contralateral carotid arteries in post-operative conditions.

Background and objectiveCalcific obstruction of the pulmonary conduit is a late complication of surgical implantation of a homograft in congenital patients. Percutaneous pulmonary valve implantation (PPVI) is an effective alternative to surgical repair. However, this procedure is affected by several complications, with coronary artery (CA) compression being one of the most severe. High-fidelity finite element (FE) models can provide accurate predictions but are too computationally expensive for routine use, whereas simplified models sacrifice mechanical fidelity. This study proposes a novel FE-based framework to investigate conduit pre-stenting feasibility, while aiming to balance computational efficiency with predictive accuracy within clinically relevant timelines.MethodsA semi-automated pipeline was developed, requiring manual input only for the segmentation of computed tomography (CT), virtual stent positioning, and simulation launch. Patient-specific geometries were meshed and processed through an automated in-house script, generating ready-to-run Abaqus input files. A multifactorial CA compression risk index was introduced, integrating baseline and post-expansion distances between the pulmonary artery and CA, and their changes during the procedure. The FE simulation of the pre-stenting procedure was tested on 10 PPVI candidates, simulating CP-stent implantation. Simulation accuracy was assessed against fluoroscopy-derived stent diameters.ResultsThe full simulation process required less than 10 h per case, with minimal operator workload. FE-predicted stent configuration showed strong agreement with fluoroscopic measurements (R2 = 0.87), with a mean absolute error of 3.5 ± 4.4%. Accuracy was highest in patients with calcific volumes <0.8 cm3 (error <0.5 mm). CA compression index identified 2 high-risk, 2 moderate-risk, and 6 negligible-risk patients. Peri-procedural fluoroscopy was not available for one negligible-risk patient; it excluded CA compression for the remaining negligible-risk patients (true negatives), for all moderate-risk patients, and for one high-risk patient (false positive); it highlighted CA compression for the remaining high-risk patient (true positive).ConclusionsThe proposed FE simulation framework enables patient-specific prediction of stent configuration and CA compression risk within clinically compatible timelines. The balanced trade-off between mechanical fidelity and computational efficiency supports its potential integration into pre-procedural planning of conduit pre-stenting and PPVI.

The aim of this paper is to evaluate the correlation between the coronary calcium score (CCS) and coronary artery disease (CAD), patients underwent coronary CT angiography (CTA). Four hundred and five patients who underwent a coronary CT with CCS analysis were considered for this retrospective study. Coronary CTA was performed using a dual-source (256-slice) CT scanner (SOMATOM Definition Flash, Siemens Healthcare, Forchheim, Germany). Before injecting the contrast medium, non-contrasted cardiac CT was performed in a longitudinal scan field from the tracheal carina down to the diaphragm. The corresponding images for calcium scoring were reconstructed with a slice width of 1.5 mm and a slice interval of 1 mm, and the tube voltage was 120 kVp. The total calcium score was calculated using dedicated software. The calcium score based on the Agatston method was defined as the presence of a lesion with an area greater than 1 mm2 and peak intensity greater than 130 Hounsfield Units, which was automatically identified and marked with color by the software. From the radiological report, the degree of coronary stenosis was retrieved. A score of 1 corresponds to the absence of stenosis, a score of 2 to mild stenosis (<50%), and a score of 3 to moderate/severe stenosis (>50%). The total coronary gravity score (CGS) for each patient was calculated by summing the score of each coronary artery. The Spearman test was used for correlation. Out of the 405 patients, 217 were male. The mean and standard deviation age was 72 ± 11 years. The overall amount of calcium was an Agatston score of 393 ± 709. A positive correlation between CCS and CGS was found (r = 0.835 and p < 0.001). A ROC curve with AUC 0.917 (p ≤ 0.001) was obtained. The optimal cutoff point of the calcium score for discriminating CGS < 2 was 112, yielding sensitivity of 90% and specificity of 81%. This study confirms the important relationship between the coronary artery calcium score and the presence and extension of coronary artery disease.

Objective: To investigate the association between sarcopenia, as appraised with CT-derived muscle metrics, and cardiovascular status, as assessed via coronary CT angiography (CCTA) using the Coronary Artery Disease-Reporting and Data System (CAD-RADS) and with pericoronary adipose tissue (pCAT) metrics. Methods: A retrospective observational study conducted on patients who underwent CCTA. The cross-sectional area (CSA) and attenuation values of the paravertebral muscles at the T8 level and the pectoralis major muscles at the T6 level were measured. The patient height was employed for the normalization of the skeletal muscle CSA. The pCAT attenuation around the coronary arteries was assessed, and the CAD severity was graded using the CAD-RADS reporting system. Regression analyses were performed to assess the impact of demographics, clinical factors, and CT variables on the CAD-RADS and pCAT. Results: A total of 220 patients were included (132 males, median age 65 years). Regression analyses showed the associations of CAD with age and sex (p < 0.001). Familiarity with CAD was related to the left anterior descending artery pCAT (p = 0.002) and circumflex artery pCAT (p = 0.018), whereas age was related to the left anterior descending artery pCAT (p = 0.032). Weak positive correlations were found between the lower muscle density and lower pCAT attenuation (ρ = 0.144–0.240, p < 0.039). Conclusions: This study demonstrated weak associations between the sarcopenia indicators and the cardiovascular risk, as assessed by the CAD severity and pCAT inflammation. However, these correlations were not strong predictors of CAD severity, as age and traditional cardiovascular risk factors overshadowed the impact of sarcopenia in the cardiovascular risk assessment.

In the last decade, artificial intelligence (AI) has influenced the field of cardiac computed tomography (CT), with its scope further enhanced by advanced methodologies such as machine learning (ML) and deep learning (DL). The AI-driven techniques leverage large datasets to develop and train algorithms capable of making precise evaluations and predictions. The realm of cardiac CT is expanding day by day and multiple tools are offered to answer different questions. Coronary artery calcium score (CACS) and CT angiography (CTA) provide high-resolution images that facilitate the detailed anatomical evaluation of coronary plaque burden. New tools such as myocardial CT perfusion (CTP) and fractional flow reserve (FFR CT ) have been developed to add a functional evaluation of the stenosis. Moreover, epicardial adipose tissue (EAT) is gaining interest as its role in coronary artery plaque development has been deepened. Seen the great added value of these tools, the demand for new exams has increased such as the burden on imagers. Due to its ability to fast compute multiple data, AI can be helpful in both the acquisition and post-processing phases. AI can possibly reduce radiation dose, increase image quality, and shorten image analysis time. Moreover, different types of data can be used for risk assessment and patient risk stratification. Recently, the focus of the scientific community on AI has led to numerous studies, especially on CACS and CTA. This narrative review concentrates on AI's role in the post-processing of CACS, CTA, FFR CT , CTP, and EAT, discussing both current capabilities and future directions in the field of cardiac imaging.

The environmental footprint of iodinated contrast agents (ICAs) and gadolinium-based contrast agents (GBCAs) is noteworthy. This study assesses: (1) patients’ “green sensitivity” as measured by their acceptance in a sustainability study and (2) the resulting potential reduction of contrast residuals in wastewater. After ethical approval, participants scheduled for administration of ICAs or GBCAs for diagnostic purposes were enrolled in this prospective observational study from July 2022 to October 2023. They were asked to prolong their hospital stay by up to 60 min to collect their first urine in dedicated canisters, thereby measuring the recovery rates of ICAs and GBCAs as found/theoretical ratio of concentrations. Mann–Whitney U, χ2 tests, and multivariable regression analysis were used. Patients scheduled for contrast-enhanced CT or MRI (n = 455) were screened; 422 (92.7

Patients with carotid stenosis can receive indication for either carotid endarterectomy (CEA) or carotid artery stenting (CAS), with both techniques having an impact on the autonomic function and baroreflex control.Seventy carotid stenosis patients randomly assigned to CEA or CAS were enrolled. After exclusion of some recordings, 33 CEA (age 67.79 +/- 5.32 yrs, 26 males) and 25 CAS (age 70.32 +/- 3.63 yrs, 14 males) were admitted to analysis. Autonomic and baroreflex sensitivity markers were derived from the analysis of heart period and systolic arterial pressure spontaneous variability derived in supine position and during active standing (STAND), before (PRE) the intervention and after a 6 and 12-month follow-up (FU6, FU12).CEA had a preserved response of autonomic and baroreflex control to STAND in PRE and FU6, suggesting an early improvement. CAS had a similar response at PRE but a blunted one at the follow-ups. When directly compared, the two groups had a similar autonomic function, with CAS having a reduced baroreflex control in PRE and lower autonomic function at FU6. All the differences disappeared at the long-term follow-up, showing a similar long term effect of the surgical procedures, suggesting that CEA and CAS induced a similar long-term impairment of autonomic and baroreflex controls.

IntroductionNon-invasive evaluation of myocardial tissue is a major goal of cardiac imaging. This is the case of myocardial fibrosis which is crucial in many myocardial diseases. Cardiac extracellular volume (ECV) was shown to indicate myocardial fibrosis and early cardiac involvement. With this study, our objective is to evaluate ECV measured with cardiac magnetic resonance (CMR) in patients with myotonic dystrophy type 1 (DM1) and 2 (DM2) as potential imaging biomarkers of subclinical cardiac pathology, and its relationship with demographic and clinical parameters, ECG-derived measures of cardiac conduction, and neuromuscular performance status.Materials and methodsWe retrospectively analyzed 18 DM1 patients and 4 DM2 patients without apparent cardiac disease who had CMR at our center. Differences between independent distributions were evaluated using Mann–Whitney U test, while correlations were evaluated using Spearman’s ρ.ResultsGlobal ECV in DM1 patients (median 28.36; IQR 24.81–29.77) was significantly higher (p = 0.0141) than in DM2 patients (median 22.93; IQR 21.25–24.35), and than that reported in literature in healthy subjects (p = 0.0374; median 25.60; IQR 19.90–31.90). Septal ECV was significantly higher (p = 0.0074) in DM1 (median 27.37; IQR 25.97–29.74) than in DM2 patients (median 22.46; 21.57–23.19). Global ECV showed a strong, positive correlation with septal ECV (ρ = 0.9282, p < 0.0001). We observed that DM1 women showed significantly higher global (p = 0.0012) and septal (p < 0.0001) ECV values compared to men.DiscussionWe found a significant increase in global and septal cardiac ECV in patients with DM1. These values might thus suggest that DM1 patients present an increased cardiovascular risk, mainly due to cardiac fibrosis, even in absence of overt cardiac pathology at other common cardiovascular exams. DM1 patients may also be at increased risk of early septal fibrosis, with important implications on the risk for fatal arrhythmias. In addition, our results suggest the presence of gender-related differences, with DM1 women being more prone to myocardial fibrosis. Physicians dealing with DM1 may consider CMR as a screening tool for the early identification of patients with increased cardiovascular risk.

BACKGROUND:The recognition of epicardial adipose tissue (EAT) as a cardiac risk factor has increased the interest in strategies that target cardiac adipose tissue. AIM:The effect of bariatric and metabolic surgery (BMS)-induced weight loss on EAT volume was evaluated in this study. METHODS:Fifteen bariatric patients, with (MS) or without (wMS) Metabolic Syndrome, underwent magnetic resonance imaging (MRI) using an open-bore scanner to assess EAT volume, visceral adipose tissue (VAT) thickness, and other cardiac morpho-functional parameters at baseline and 12 months after BMS. Nine patients underwent laparoscopic sleeve gastrectomy (LSG), and 6 patients underwent Roux-en-Y Gastric Bypass (RYGBP). RESULTS:EAT volume significantly decreased in all the patients 12 months post-BMS from 91.6 cm3 to 67.1 cm3; p = 0.0002 in diastole and from 89.4 cm3 to 68.2 cm3; p = 0.0002 in systole. No significant difference was found between the LSG and RYGBP group. Moreover, EAT volume was significantly reduced among wMS compared with MS. In particular, EAT volume in diastole was significantly reduced from 80.9 cm3 to 54.4 cm3; p = 0.0156 in wMS and from 98.3 cm3 to 79.5 cm3; p = 0.031 in MS. The reduction was also confirmed in systole from 81.2 cm3 to 54.1 cm3; p = 0.0156 in wMS and from 105.7 cm3 to 75.1 cm3; p = 0.031 in MS. Finally, a positive correlation was found between EAT loss, BMI (r = 0.52; p = 0.0443) and VAT (r = 0.66; p = 0.008) reduction after BMS. CONCLUSION:These findings suggest that EAT reduction may be a fundamental element for improving the cardio-metabolic prognosis of bariatric patients. Moreover, this is the first study performed with an open-bore MRI scanner to measure EAT volume.

Il tessuto adiposo epicardico (EAT) è un fattore di rischio cardiovascolare in quanto promuove la progressione della fibrillazione atriale, della malattia coronarica e dell’insufficienza cardiaca. EAT si caratterizza per rapido metabolismo, misurabilità clinica e facile modificabilità e rappresenta un bersaglio terapeutico peculiare per farmaci innovativi, quali gli agonisti del recettore del peptide glucagone-simile 1 e gli inibitori del co-trasportatore sodio-glucosio 2, che appaiono salutari dal punto di vista cardiometabolico ben oltre i loro effetti sul glucosio e sul peso corporeo (Materiale Supplementare).

BACKGROUND AND OBJECTIVE:Dysfunction of the right ventricular outflow tract (RVOT) is a common long-term complication following surgical repair in patients with congenital heart disease. Transcatheter pulmonary valve implantation (TPVI) offers a viable alternative to surgical pulmonary valve replacement (SPVR) for treating pulmonary regurgitation but not all RVOT anatomies are suitable for TPVI. To identify a suitable landing zone (LZ) for TPVI, three-dimensional multiphase (4D) computed tomography (CT) is used to evaluate the size, shape, and dynamic behavior of the RVOT throughout the cardiac cycle. However, manually extracting measurements from multiplanar CT reformats is operator-dependent and time-consuming. Leveraging an optical-flow (OF) algorithm, we proposed a novel semi-automated pipeline for dynamic and comprehensive geometrical analysis of the RVOT anatomy. METHODS:Upon 4D-CT availability, at a pre-defined reference time-point, the patient-specific anatomy is semi-automatically segmented to generate the corresponding three-dimensional surface, which is navigated through a graphical user interface to define the mid-section of the potential LZ. Based on the axial length of the intended device, the proximal and distal LZ cross-sections are automatically identified. An OF-based algorithm is used to track the three LZ cross-sections frame by frame throughout the cardiac cycle, taking RVOT out-of-plane motion into account to update RVOT contours on each cross-section and to elaborate LZ geometrical changes. Finally, LZ time-dependent geometrical features are quantified and extracted. RESULTS:The pipeline was successfully applied to a retrospective cohort of patients, with OF-based tracking reporting excellent agreement (r2 = 0.99) compared to manual processing, with a bias < 1% for both LZ area and perimeter, while also significantly improving time efficiency. CT-derived measurements extracted from LZ mid-section were the most influential covariates affecting the likelihood of TPVI feasibility. Among these, the minimum perimeter outperformed all other geometric LZ parameters in classifying patients as suitable for either TPVI or SPVR and achieved the highest area under the curve of 0.99, with accuracy and precision of 0.93 and 0.92, respectively. CONCLUSIONS:Dynamic OF-based quantification of key RVOT geometric parameters can enhance and expedite the selection process for TPVI candidates and guide optimal valve sizing during TPVI planning.

Journal Article Cardiac magnetic resonance in the assessment of the anomalous right coronary artery originating from the left sinus of Valsalva Get access Alberto Cipriani, Alberto Cipriani Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padua, ItalyCardiology Unit, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy https://orcid.org/0000-0001-7842-6202 Search for other works by this author on: Oxford Academic PubMed Google Scholar Mauro Lo Rito, Mauro Lo Rito Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy https://orcid.org/0000-0002-3175-3764 Search for other works by this author on: Oxford Academic PubMed Google Scholar Silvia Pica, Silvia Pica Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Monica De Gaspari, Monica De Gaspari Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padua, ItalyCardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy https://orcid.org/0000-0001-9528-4883 Search for other works by this author on: Oxford Academic PubMed Google Scholar Ilaria Rigato, Ilaria Rigato Cardiology Unit, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Martina Perazzolo Marra, Martina Perazzolo Marra Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padua, ItalyCardiology Unit, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy https://orcid.org/0000-0001-7645-6993 Search for other works by this author on: Oxford Academic PubMed Google Scholar Giorgio De Conti, Giorgio De Conti Radiology Unit, University Hospital of Padua, Padua, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Simone Corradin, Simone Corradin Radiology Unit, University Hospital of Padua, Padua, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Raffaella Motta, Raffaella Motta Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padua, ItalyRadiology Unit, University Hospital of Padua, Padua, Italy https://orcid.org/0000-0002-1886-9826 Search for other works by this author on: Oxford Academic PubMed Google Scholar Valeria Pergola, Valeria Pergola Cardiology Unit, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar ... Show more Francesco Secchi, Francesco Secchi Department of Biomedical Sciences for Health, University of Milan, Milan, ItalyUnit of Radiology, IRCCS Policlinico San Donato, Milan, Italy https://orcid.org/0000-0002-0357-1808 Search for other works by this author on: Oxford Academic PubMed Google Scholar Massimo Lombardi, Massimo Lombardi Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan, Italy https://orcid.org/0000-0003-1700-8749 Search for other works by this author on: Oxford Academic PubMed Google Scholar Barbara Bauce, Barbara Bauce Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padua, ItalyCardiology Unit, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy https://orcid.org/0000-0001-7357-293X Search for other works by this author on: Oxford Academic PubMed Google Scholar Alessandro Zorzi, Alessandro Zorzi Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padua, ItalyCardiology Unit, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy https://orcid.org/0000-0002-3578-0583 Search for other works by this author on: Oxford Academic PubMed Google Scholar Gaetano Thiene, Gaetano Thiene Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padua, ItalyCardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy https://orcid.org/0000-0002-8814-2577 Search for other works by this author on: Oxford Academic PubMed Google Scholar Cristina Basso, Cristina Basso Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padua, ItalyCardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy https://orcid.org/0000-0002-0195-9753 Search for other works by this author on: Oxford Academic PubMed Google Scholar Silvana Molossi, Silvana Molossi Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA https://orcid.org/0000-0001-9767-9512 Search for other works by this author on: Oxford Academic PubMed Google Scholar Massimo Antonio Padalino, Massimo Antonio Padalino Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padua, ItalyPediatric and Congenital Cardiac Surgery Unit, University Hospital of Padua, Padua, Italy https://orcid.org/0000-0002-7535-9670 Search for other works by this author on: Oxford Academic PubMed Google Scholar Domenico Corrado Domenico Corrado Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, 35128 Padua, ItalyCardiology Unit, University Hospital of Padua, Via Giustiniani, 2, 35128 Padua, Italy Corresponding author. Tel: +39 049 8212458, Fax: +39 049 8212309, Email: domenico.corrado@unipd.it https://orcid.org/0000-0003-1487-0392 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, ehae129, https://doi.org/10.1093/eurheartj/ehae129 Published: 05 March 2024

This work aimed to automatically segment and classify the coronary arteries with either normal or anomalous origin from the aorta (AAOCA) using convolutional neural networks (CNNs), seeking to enhance and fasten clinician diagnosis. We implemented three single-view 2D Attention U-Nets with 3D view integration and trained them to automatically segment the aortic root and coronary arteries of 124 computed tomography angiographies (CTAs), with normal coronaries or AAOCA. Furthermore, we automatically classified the segmented geometries as normal or AAOCA using a decision tree model. For CTAs in the test set ( n = 13), we obtained median Dice score coefficients of 0.95 and 0.84 for the aortic root and the coronary arteries, respectively. Moreover, the classification between normal and AAOCA showed excellent performance with accuracy, precision, and recall all equal to 1 in the test set. We developed a deep learning-based method to automatically segment and classify normal coronary and AAOCA. Our results represent a step towards an automatic screening and risk profiling of patients with AAOCA, based on CTA.

Abstract Background Cardiac magnetic resonance (CMR) characterization of myocardial tissue is routinely used in clinical practice. Compared to traditional CT, Photon counting CT (PCCT) uses photon-counting detectors offering higher spatial resolution, elimination of electronic noise and improved contrast-to-noise ratio. A comparison between CMR and PCCT for myocardial characterizazion in an urgent setting, however, has not yet been explored. Purpose The aim of this study was to compare the ability to characterize myocardial tissue between PCCT and CMR in patients presenting with acute chest pain in the emergency department (ED). Methods This single-center prospective study enrolled all consecutive patients presenting to the ED of our hospital from November 2023 to January 2024 with chest pain, ECG alterations and troponin rise consistent with myocardial injury. Patients needing urgent coronary angiography according to guidelines were excluded. PCCT was performed urgently for triple rule-out, but also for tissue characterization through post-iodine-contrast administration images. Within 24 hours, all patients underwent a CMR protocol including T2-weighted and late gadolinium enhancement (LGE) images for tissue characterization. Results Six male patients with a mean age of 20 ± 10 years were enrolled. All clinical, PCCT, and CMR parameters are presented in Table 1. All patients presented with diffuse ST-segment elevation and exhibited T2-weighted images (for edema detection) and LGE distribution (subepicardial and intramyocardial) consistent with acute myocarditis. Mean radiation exposure for PCCT was 0.8±0.1 mSv. A strong linear correlation emerged between PCCT-derived delayed enhancement (DE) volume and CMR-derived late gadolinium enhancement (LGE) volume (r = 0.970; p value 0.001) (Table 1). Similar results were achieved when comparing the number of DE and LGE myocardial segments (r = 0.871; p value 0.026). Significant correlations also emerged between DE, LGE, and high-sensitive troponin (hsTN) at presentation (respectively: PCCT-DE vs hsTN r = 0.951, p value 0.004; CMR-LGE vs hsTN r = 0.918, p value 0.010). CMR showed a much higher signal-to-noise ratio (SNR) for the delayed enhanced myocardium and contrast-to-noise (CNR) ratio between the delayed enhanced and normal myocardium with respect to PCCT in post-contrast images (respectively 7.4 ± 3.9 vs 27.2 ± 17.7, p value 0.024 and 5.5 ± 3.7 vs 38.8 ± 30.2, p value 0.023). In T2-weighted images both SNR for the hyperintense myocardium (30.3 [20.4-122.4]) and CNR between the hyperintense and normal myocardium (26.7 [13.3-60.2]) resulted to be higher compared to PCCT (p value 0.027 and 0.045, respectively) (Table 1). Conclusions PCCT appears to be reliable when compared to CMR for detecting myocardial edema through the acquisition of post-contrast images in the acute setting with an acceptable CNR.

Background: Perivascular adipose tissue (PVAT) attenuation has emerged as a novel biomarker for identifying high-risk arterial plaques due to its association with inflammation. Recognizing the systemic nature of atherosclerosis and its link with major cardiovascular events in coronary disease, this study evaluated PVAT attenuation in the peripheral arteries using CT imaging to expand the understanding of its diagnostic and prognostic potential. Methods: a retrospective analysis of 53 consecutive patients who underwent CT angiography, examining PVAT density across five primary peripheral arterial segments. A 5 mm region of interest adjacent to the vascular wall was analyzed by two blinded readers, with reproducibility coefficients calculated to determine the reliability of the measurements. For the statistical analyses, mean values were derived from these measurements. The patients were stratified into four groups based on the degree of arterial stenosis: <25%, 25–50%, 50–70%, and >70%. PVAT density comparisons between these groups were performed using the Kruskal–Wallis test and the pairwise Mann–Whitney U test with Holm–Bonferroni correction for multiple comparisons. Results: the Kruskal–Wallis test revealed statistically significant disparities in PVAT density across the categorically differentiated stenosis groups (p < 0.001), indicating an association between PVAT density and arterial stenosis severity. This association was especially pronounced in the external iliac, common femoral, superficial femoral, and popliteal arteries, where the p-values were consistently below 0.05. Subsequent pairwise analyses utilizing the Mann–Whitney U test with Holm–Bonferroni correction affirmed these findings, in particular for the external iliac, common femoral, superficial femoral and popliteal arteries (p < 0.05). Conclusions: our findings reinforce the correlation between increased PVAT density and the degree of arterial stenosis, supporting the clinical value of PVAT as a non-invasive biomarker for cardiovascular risk stratification and potentially guiding therapeutic interventions.