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Article ; Online: Computed Tomography Pulmonary Angiography Prediction of Adverse Long-Term Outcomes in Chronic Thromboembolic Pulmonary Hypertension: Correlation with Hemodynamic Measurements Pre- and Post-Pulmonary Endarterectomy.

Gopalan, Deepa / Riley, Jan Y J / Leong, Kai'en / Alsanjari, Senan / Auger, William / Lindholm, Peter

Tomography (Ann Arbor, Mich.)

2023 Volume 9, Issue 5, Page(s) 1787–1798

Abstract: CT pulmonary angiography is commonly used in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). This work was conducted to determine if cardiac chamber size on CTPA may also be useful for predicting the outcome of CTEPH treatment. A ... ...

Abstract	CT pulmonary angiography is commonly used in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). This work was conducted to determine if cardiac chamber size on CTPA may also be useful for predicting the outcome of CTEPH treatment. A retrospective analysis of paired CTPA and right heart hemodynamics in 33 consecutive CTEPH cases before and after pulmonary thromboendarterectomy (PTE) was performed. Semiautomated and manual CT biatrial and biventricular size quantifications were correlated with mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and cardiac output. The baseline indexed right atrioventricular volumes were twice the left atrioventricular volumes, with significant (
MeSH term(s)	Humans ; Hypertension, Pulmonary/diagnostic imaging ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/surgery ; Pulmonary Embolism/complications ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/surgery ; Retrospective Studies ; Hemodynamics ; Angiography ; Tomography, X-Ray Computed ; Endarterectomy/methods
Language	English
Publishing date	2023-09-26
Publishing country	Switzerland
Document type	Journal Article
ISSN	2379-139X
ISSN (online)	2379-139X
DOI	10.3390/tomography9050142
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Troponin least significant change (z-score) is associated with poor clinical outcomes in patients presenting to the emergency department.

Smith, Joel D / Leong, Kai'En / Fazio, Timothy / Chiang, Cherie

Annals of clinical biochemistry

2021 Volume 58, Issue 4, Page(s) 297–304

Abstract: Background: A rise and/or fall in high sensitivity cardiac troponin (hs-Tn) is critical in defining acute myocardial injury and therefore the diagnosis of acute myocardial infarction. A significant rise in hs-Tn is not well defined in current guidelines. ...

Abstract	Background: A rise and/or fall in high sensitivity cardiac troponin (hs-Tn) is critical in defining acute myocardial injury and therefore the diagnosis of acute myocardial infarction. A significant rise in hs-Tn is not well defined in current guidelines. Calculation of a z-score for two consecutive hs-Tn measurements is a method-independent measure of dynamic troponin elevation. However, the association of hs-Tn z-score with outcomes for unselected emergency department admissions is unknown. Moreover, the association of non-dynamic troponin elevations, as defined by a normal z-score, with clinical outcomes remains to be assessed. Methods: We retrospectively calculated z-scores for patients presenting to emergency department over 18 months who had serial troponin measurements with at least one result >99th percentile using the Abbott hs-TnI assay. We assessed the association of z-score with discharge diagnosis, cardiac interventions, inpatient mortality, length of stay and readmission rates. Results: There were 2062 presentations for 1830 patients where a z-score was calculated. Z-score was elevated in 1080 presentations. Dynamic troponin elevation (z-score ≥ 2) was associated with acute myocardial infarction (OR = 9.1, Conclusions: Z-score is an assay-independent tool to alert clinicians of significant, dynamic troponin elevation and acute myocardial injury. It is associated with poorer clinical outcomes.
MeSH term(s)	Acute Coronary Syndrome/blood ; Biomarkers/blood ; Cardiology ; Clinical Laboratory Techniques/standards ; Emergency Service, Hospital ; Humans ; Length of Stay ; Myocardial Infarction/blood ; Odds Ratio ; Patient Admission ; Reproducibility of Results ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Treatment Outcome ; Troponin/blood
Chemical Substances	Biomarkers ; Troponin
Language	English
Publishing date	2021-02-17
Publishing country	England
Document type	Journal Article
ZDB-ID	390309-6
ISSN	1758-1001 ; 0004-5632
ISSN (online)	1758-1001
ISSN	0004-5632
DOI	10.1177/0004563221992812
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Zs.A 889: Show issues

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Article: Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status.

Leong, Kai'En / Howard, Luke / Giudice, Francesco Lo / Davies, Rachel / Haji, Gulammehdi / Gibbs, Simon / Gopalan, Deepa

Pulmonary circulation

2023 Volume 13, Issue 1, Page(s) e12116

Abstract: Chronic thromboembolic pulmonary hypertension may be cured by pulmonary endarterectomy (PEA). Thromboembolic disease distribution/PEA success primarily determines prognosis but risk scoring criteria may be adjunctive. Right ventriculoarterial (RV-PA) and ...

Abstract	Chronic thromboembolic pulmonary hypertension may be cured by pulmonary endarterectomy (PEA). Thromboembolic disease distribution/PEA success primarily determines prognosis but risk scoring criteria may be adjunctive. Right ventriculoarterial (RV-PA) and ventriculoatrial (RV-right atrium [RA]) coupling may be evaluated by cardiac MRI (CMR) feature tracking deformation/strain assessment. We characterized biatrial and biventricular CMR feature tracking (FT) strain parameters following PEA and tested the ability of CMR FT to identify REVEAL 2.0 high-risk status. We undertook a retrospective single-center cross-sectional study of patients (
Language	English
Publishing date	2023-02-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2638089-4
ISSN	2045-8940 ; 2045-8932
ISSN (online)	2045-8940
ISSN	2045-8932
DOI	10.1002/pul2.12116
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Article ; Online: Pulmonary Vein Sign on Computed Tomography Pulmonary Angiography in Proximal and Distal Chronic Thromboembolic Pulmonary Hypertension With Hemodynamic Correlation.

Gopalan, Deepa / Riley, Jan Y J / Leong, Kai'en / Guo, Haiwei Henry / Zamanian, Roham T / Hsi, Andrew / Auger, William / Lindholm, Peter

Journal of thoracic imaging

2023 Volume 38, Issue 3, Page(s) 159–164

Abstract: Background: Pulmonary vein sign (PVS) indicates abnormal pulmonary venous flow on computed tomography pulmonary angiography (CTPA) is a frequent finding in proximal chronic thromboembolic pulmonary hypertension (CTEPH). PVS's occurrence in distal CTEPH ... ...

Abstract	Background: Pulmonary vein sign (PVS) indicates abnormal pulmonary venous flow on computed tomography pulmonary angiography (CTPA) is a frequent finding in proximal chronic thromboembolic pulmonary hypertension (CTEPH). PVS's occurrence in distal CTEPH and correlation to disease severity is unknown. Using right heart catheterization data, we evaluated the relationship between PVS and CTEPH disease distribution and severity. Materials and method: A total of 93 consecutive CTEPH cases with both CTPA and right heart catheterization were identified in this retrospective multi-institutional study. After excluding 17 cases with suboptimal CTPA, there were 52 proximal and 24 distal CTEPH cases. Blood flow in the major pulmonary veins was graded qualitatively. Subgroup analysis of PVS was performed in 38 proximal CTEPH cases before and after pulmonary endarterectomy. Results: PVS was more frequent in proximal (79%) than distal CTEPH (29%) ( P <0.001). No significant difference was noted in invasive mean pulmonary artery pressure (46±11 and 41±12 mm Hg) or pulmonary vascular resistance (9.4±4.5 and 8.4±4.8 WU) between the 2 groups. In the subgroup analysis, PVS was present in 29/38 patients (76%) before surgery. Postoperatively, 33/38 cases (87%, P <0.001) had normal venous flow (mean pulmonary artery pressure 46±11 and 25; pulmonary vascular resistance 9.2±4.3 and 2.6 WU preop and postop, respectively). Conclusion: PVS is a common feature in proximal but infrequent findings in distal CTEPH. PVS does not correlate with hemodynamic severity. PVS resolution was seen in the majority of patients following successful endarterectomy.
MeSH term(s)	Humans ; Hypertension, Pulmonary/complications ; Hypertension, Pulmonary/diagnostic imaging ; Pulmonary Veins ; Pulmonary Embolism/complications ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/surgery ; Retrospective Studies ; Chronic Disease ; Hemodynamics ; Angiography/methods ; Tomography
Language	English
Publishing date	2023-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	632900-7
ISSN	1536-0237 ; 0883-5993
ISSN (online)	1536-0237
ISSN	0883-5993
DOI	10.1097/RTI.0000000000000706
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Zs.A 2187: Show issues

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Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Native aorto-ostial coronary lesions on CT coronary angiogram.

Riley, Jan Y J / Leong, Kai'En / Mortensen, Kristian H / Ariff, Ben / Gopalan, Deepa

The British journal of radiology

2021 Volume 94, Issue 1123, Page(s) 20210211

Abstract: Aorto-ostial coronary lesions (AOLs) are important to detect due to the high risk of catastrophic consequences. Unfortunately, due to the complexities of these lesions, they may be missed on invasive coronary angiography. Computed tomography coronary ... ...

Abstract	Aorto-ostial coronary lesions (AOLs) are important to detect due to the high risk of catastrophic consequences. Unfortunately, due to the complexities of these lesions, they may be missed on invasive coronary angiography. Computed tomography coronary angiogram (CTCA) is highly sensitive and specific in detecting AOLs, and has the additional advantage of demonstrating the surrounding anatomy. CTCA is particularly useful when assessing for AOL aetiologies in addition to atherosclerotic disease,
MeSH term(s)	Aorta, Thoracic/abnormalities ; Aorta, Thoracic/diagnostic imaging ; Aortic Diseases/diagnostic imaging ; Computed Tomography Angiography/methods ; Coronary Angiography/methods ; Coronary Disease/diagnostic imaging ; Coronary Vessel Anomalies/diagnostic imaging ; Humans ; Sensitivity and Specificity
Language	English
Publishing date	2021-06-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20210211
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Article ; Online: Complex transposition of the great arteries with pulmonary arterial hypertension and giant pulmonary artery aneurysm.

Leong, Kai'En / Joshi, Subodh / Grigg, Leeanne

European heart journal. Case reports

2018 Volume 2, Issue 1, Page(s) yty012

Language	English
Publishing date	2018-02-14
Publishing country	England
Document type	Journal Article
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/yty012
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Article: MRI Feature Tracking Strain in Pulmonary Hypertension: Utility of Combined Left Atrial Volumetric and Deformation Assessment in Distinguishing Post- From Pre-capillary Physiology.

Leong, Kai'En / Howard, Luke / Lo Giudice, Francesco / Pavey, Holly / Davies, Rachel / Haji, Gulammehdi / Gibbs, Simon / Gopalan, Deepa

Frontiers in cardiovascular medicine

2022 Volume 9, Page(s) 787656

Abstract: Aims: Pulmonary hypertension (PH) is dichotomized into pre- and post-capillary physiology by invasive catheterization. Imaging, particularly strain assessment, may aid in classification and be helpful with ambiguous hemodynamics. We sought to define ... ...

Abstract	Aims: Pulmonary hypertension (PH) is dichotomized into pre- and post-capillary physiology by invasive catheterization. Imaging, particularly strain assessment, may aid in classification and be helpful with ambiguous hemodynamics. We sought to define cardiac MRI (CMR) feature tracking biatrial peak reservoir and biventricular peak systolic strain in pre- and post-capillary PH and examine the performance of peak left atrial strain in distinguishing the 2 groups compared to TTE. Methods and results: Retrospective cross-sectional study from 1 Jan 2015 to 31 Dec 2020; 48 patients (22 pre- and 26 post-capillary) were included with contemporaneous TTE, CMR and catheterization. Mean pulmonary artery pressures were higher in the pre-capillary cohort (55 ± 14 vs. 42 ± 9 mmHg; Conclusion: CMR volumetric and deformation assessment of the left atrium can highly accurately distinguish post- from pre-capillary PH.
Language	English
Publishing date	2022-03-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2022.787656
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Article ; Online: Biatrial Volumetric Assessment by Non-ECG-Gated CT Pulmonary Angiography Correlated with Transthoracic Echocardiography in Patients with Normal Diastology.

Gopalan, Deepa / Riley, Jan / Leong, Kai'En / Alsanjari, Senan / Ariff, Ben / Auger, Willam / Lindholm, Peter

Tomography (Ann Arbor, Mich.)

2022 Volume 8, Issue 6, Page(s) 2761–2771

Abstract: Atrial size is a predictor of cardiovascular mortality. Non-ECG-gated computed tomography pulmonary angiography (CTPA) is a common test for cardiopulmonary evaluation but normative values for biatrial volumes are lacking. We derived normal CT biatrial ... ...

Abstract	Atrial size is a predictor of cardiovascular mortality. Non-ECG-gated computed tomography pulmonary angiography (CTPA) is a common test for cardiopulmonary evaluation but normative values for biatrial volumes are lacking. We derived normal CT biatrial volumes using manual and semiautomated segmentation with contemporaneous transthoracic echocardiography (TTE) to confirm normal diastology. Thirty-five consecutive cases in sinus rhythm with no history of cardio-vascular, renal, or pulmonary disease and normal diastolic function were selected. Planimetric CTPA measurements were compared to TTE volumes measured using area length method. TTE and CTPA derived normal LAVi and RAVi were 27 + 5 and 20 + 6 mL/m
MeSH term(s)	Humans ; Angiography ; Echocardiography ; Heart Atria/diagnostic imaging ; Tomography, X-Ray Computed
Language	English
Publishing date	2022-11-17
Publishing country	Switzerland
Document type	Journal Article
ISSN	2379-139X
ISSN (online)	2379-139X
DOI	10.3390/tomography8060230
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Article ; Online: Misguided diversions: coronary artery fistulae.

Leong, Kai'En / Joshi, Subodh / Grigg, Leeanne

European heart journal

2017 Volume 38, Issue 27, Page(s) 2150

MeSH term(s)	Acute Coronary Syndrome/diagnostic imaging ; Aged ; Coronary Angiography ; Coronary Sinus/diagnostic imaging ; Coronary Vessel Anomalies/complications ; Coronary Vessel Anomalies/diagnostic imaging ; Coronary Vessels/diagnostic imaging ; Echocardiography, Stress ; Female ; Humans ; Middle Aged ; Takotsubo Cardiomyopathy/complications ; Vascular Fistula/complications ; Vascular Fistula/diagnostic imaging
Language	English
Publishing date	2017-04-13
Publishing country	England
Document type	Case Reports ; Journal Article ; Video-Audio Media
ZDB-ID	603098-1
ISSN	1522-9645 ; 0195-668X
ISSN (online)	1522-9645
ISSN	0195-668X
DOI	10.1093/eurheartj/ehx185
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Zs.A 1563: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 640: Show issues

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Article ; Online: Ticagrelor-associated ventricular pauses: a case report and literature review.

Low, Ashlea / Leong, Kai'En / Sharma, Anand / Oqueli, Ernesto

European heart journal. Case reports

2018 Volume 3, Issue 1, Page(s) yty156

Abstract: Background: Ticagrelor is an oral anti-platelet agent that is a reversible and direct inhibitor of the adenosine diphosphate P2Y12 receptor. Ticagrelor's brady-arrhythmic potential was investigated in a sub-study of the PLATO trial, which concluded that ...

Abstract	Background: Ticagrelor is an oral anti-platelet agent that is a reversible and direct inhibitor of the adenosine diphosphate P2Y12 receptor. Ticagrelor's brady-arrhythmic potential was investigated in a sub-study of the PLATO trial, which concluded that the effects were transient and not clinically significant beyond the acute initiation phase. Since then, there have been emerging reports of ticagrelor-associated high-degree heart block, requiring drug discontinuation and pacemaker insertion. We present a case of symptomatic ventricular pauses in a patient loaded with ticagrelor post-percutaneous coronary intervention (PCI) for non-ST elevation acute coronary syndrome (NSTEACS) and review the literature relating to ticagrelor and its brady-arrhythmic potential. Case summary: A 59-year-old female presented to our hospital with NSTEACS and received an oral load of ticagrelor 180 mg following PCI to her mid-left circumflex coronary artery. Three hours after, four pauses were observed on telemetry over a 20 min period, the longest being 18.5 s in duration. Ticagrelor was ceased and clopidogrel commenced in place. No arrhythmic events were recorded on loop recorder interrogation following ticagrelor discontinuation. Discussion: The exact mechanism of ticagrelor-induced brady-arrhythmia is unclear, although inhibition of adenosine reuptake is proposed as likely due to structural similarities between ticagrelor and adenosine. In the setting of acute coronary syndrome treated with ticagrelor, extracellular adenosine concentrations are amplified by the ischaemic milieu with myocardial adenosine release and blunted cellular reuptake. This leads to enhanced agonism of adenosine A1 receptors, causing negative chronotropy and dromotropy. This case report highlights ticagrelor's brady-arrhythmic potential even in the absence of baseline conduction disease or concurrent confounding medications.
Language	English
Publishing date	2018-12-28
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/yty156
Database	MEDical Literature Analysis and Retrieval System OnLINE

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