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  1. Article: 1H-MRS to evaluate improved triglyceride accumulation in idiopathic triglyceride deposit cardiomyovasculopathy after CNT-01 (tricaprin/trisdecanion) administration.

    Aikawa, Tatsuro / Sai, Eiryu / Kudo, Ayako / Kawaguchi, Yuko O / Takamura, Kazuhisa / Hiki, Makoto / Yokoyama, Takayuki / Miyazaki, Tetsuro / Fujimoto, Shinichiro / Shimada, Kazunori / Hirano, Ken-Ichi / Daida, Hiroyuki / Minamino, Tohru

    Endocrinology, diabetes & metabolism case reports

    2023  Volume 2023, Issue 2

    Abstract: Summary: Triglyceride deposit cardiomyovasculopathy (TGCV) is an intractable disease characterized by massive triglyceride (TG) accumulation in the myocardium and coronary arteries caused by genetic or acquired dysfunction of adipose TG lipase (ATGL). A ...

    Abstract Summary: Triglyceride deposit cardiomyovasculopathy (TGCV) is an intractable disease characterized by massive triglyceride (TG) accumulation in the myocardium and coronary arteries caused by genetic or acquired dysfunction of adipose TG lipase (ATGL). A phase IIa trial has been conducted involving patients with idiopathic TGCV using CNT-01 (tricaprin/trisdecanion) by the Japan TGCV study group, which showed that CNT-01 improved myocardial lipolysis as demonstrated by iodine-123-beta-methyl iodophenyl-pentadecanoic acid (BMIPP) scintigraphy. We evaluated changes in myocardial TG content using proton magnetic resonance spectroscopy (1H-MRS) before/after CNT-01. This report describes a male patient with hypertension, diabetes, angina pectoris, repeated percutaneous coronary intervention, chest pain, and exertional dyspnea that persisted despite standard medications and nitroglycerin. Idiopathic TGCV was diagnosed based on a remarkably reduced washout rate (WR) for BMIPP scintigraphy, high myocardial TG content on 1H-MRS, and no ATGL mutation. After an 8-week, 1.5 g/day CNT-01 administration, the WR of BMIPP increased from 5.1 to 13.3% and the myocardial TG content decreased from 8.4 to 5.9%, with no adverse effects. CNT-01 corrected myocardial lipolysis and subsequently reduced TG content in idiopathic TGCV as evaluated using 1H-MRS, which may be a useful, noninvasive evaluation of therapeutic efficacy.
    Learning points: Triglyceride deposit cardiomyovasculopathy (TGCV) is an intractable disease characterized by massive triglyceride accumulation in the myocardium and coronary arteries, caused by genetic or acquired dysfunction of adipose triglyceride lipase. Japan TGCV Study Group developed a specific treatment for idiopathic TGCV using CNT-01 (tricaprin/trisdecanion), a type of medium-chain fatty acid. CNT-01 corrected myocardial lipolysis and reduced TG content in idiopathic TGCV using proton magnetic resonance spectroscopy, which may be a useful noninvasive evaluation of therapeutic efficacy.
    Language English
    Publishing date 2023-04-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 2785530-2
    ISSN 2052-0573
    ISSN 2052-0573
    DOI 10.1530/EDM-22-0370
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  2. Article ; Online: Coronary Artery Vorticity to Predict Functional Plaque Progression in Participants with Type 2 Diabetes Mellitus.

    Tomizawa, Nobuo / Fujimoto, Shinichiro / Mita, Tomoya / Takahashi, Daigo / Nozaki, Yui / Fan, Ruiheng / Kudo, Ayako / Kawaguchi, Yuko / Takamura, Kazuhisa / Hiki, Makoto / Kurita, Mika / Kumamaru, Kanako K / Watada, Hirotaka / Minamino, Tohru / Aoki, Shigeki

    Radiology. Cardiothoracic imaging

    2023  Volume 5, Issue 4, Page(s) e230016

    Abstract: Purpose: To investigate whether vorticity could predict functional plaque progression better than high-risk plaque (HRP) and lesion length (LL) in individuals with type 2 diabetes mellitus.: Materials and methods: This single-center prospective study ...

    Abstract Purpose: To investigate whether vorticity could predict functional plaque progression better than high-risk plaque (HRP) and lesion length (LL) in individuals with type 2 diabetes mellitus.
    Materials and methods: This single-center prospective study included 61 participants (mean age, 61 years ± 9 [SD]; 43 male participants) who underwent serial coronary CT angiography at 2 years, with 20%-70% stenosis at initial CT between October 2015 and March 2020. The number of the following HRP characteristics was recorded: low attenuation, positive remodeling, spotty calcification, and napkin-ring sign. Vorticity was calculated using a mesh-free simulation. A decrease in CT fractional flow reserve larger than 0.05 indicated functional progression. Models using HRP and LL and vorticity were compared using receiver operating characteristic curve analysis.
    Results: Of the 94 vessels evaluated, 25 vessels (27%) showed functional progression. Vessels with functional progression showed higher vorticity at distal stenosis (984 sec
    Conclusion: In participants with type 2 diabetes mellitus, vorticity at distal stenosis was a better predictor of functional plaque progression than HRP and LL.
    Language English
    Publishing date 2023-08-24
    Publishing country United States
    Document type Journal Article
    ISSN 2638-6135
    ISSN (online) 2638-6135
    DOI 10.1148/ryct.230016
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  3. Article ; Online: Fully automated coronary artery calcium quantification on electrocardiogram-gated non-contrast cardiac computed tomography using deep-learning with novel Heart-labelling method.

    Takahashi, Daigo / Fujimoto, Shinichiro / Nozaki, Yui O / Kudo, Ayako / Kawaguchi, Yuko O / Takamura, Kazuhisa / Hiki, Makoto / Sato, Eisuke / Tomizawa, Nobuo / Daida, Hiroyuki / Minamino, Tohru

    European heart journal open

    2023  Volume 3, Issue 6, Page(s) oead113

    Abstract: Aims: To develop an artificial intelligence (AI)-model which enables fully automated accurate quantification of coronary artery calcium (CAC), using deep learning (DL) on electrocardiogram (ECG)-gated non-contrast cardiac computed tomography (gated CCT) ...

    Abstract Aims: To develop an artificial intelligence (AI)-model which enables fully automated accurate quantification of coronary artery calcium (CAC), using deep learning (DL) on electrocardiogram (ECG)-gated non-contrast cardiac computed tomography (gated CCT) images.
    Methods and results: Retrospectively, 560 gated CCT images (including 60 synthetic images) performed at our institution were used to train AI-model, which can automatically divide heart region into five areas belonging to left main (LM), left anterior descending (LAD), circumflex (LCX), right coronary artery (RCA), and another. Total and vessel-specific CAC score (CACS) in each scan were manually evaluated. AI-model was trained with novel Heart-labelling method
    Conclusion: Present Heart-labelling method provides a further improvement in fully automated, total, and vessel-specific CAC quantification on gated CCT.
    Language English
    Publishing date 2023-11-08
    Publishing country England
    Document type Journal Article
    ISSN 2752-4191
    ISSN (online) 2752-4191
    DOI 10.1093/ehjopen/oead113
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  4. Article ; Online: Energy loss is related to CT fractional flow reserve progression in type 2 diabetes mellitus patients.

    Tomizawa, Nobuo / Fujimoto, Shinichiro / Takahashi, Daigo / Nozaki, Yui / Fan, Ruiheng / Kudo, Ayako / Kawaguchi, Yuko / Takamura, Kazuhisa / Hiki, Makoto / Kadowaki, Satoshi / Ikeda, Fuki / Kumamaru, Kanako K / Watada, Hirotaka / Minamino, Tohru / Aoki, Shigeki

    American heart journal plus : cardiology research and practice

    2023  Volume 35, Page(s) 100328

    Abstract: Background: We aimed to investigate the diagnostic value of energy loss (EL) and baseline CT fractional flow reserve (CT-FFR) computed using computational fluid dynamics to predict functional progression of coronary stenosis in patients with type 2 ... ...

    Abstract Background: We aimed to investigate the diagnostic value of energy loss (EL) and baseline CT fractional flow reserve (CT-FFR) computed using computational fluid dynamics to predict functional progression of coronary stenosis in patients with type 2 diabetes mellitus.
    Methods: This single-center prospective study included 61 patients with type 2 diabetes mellitus (mean age, 61 years ±9 [SD]; 43 men) showing 20-70 % stenosis who underwent serial coronary CT performed at 2-year interval between October 2015 and March 2020. A mesh-free simulation was performed to calculate the CT-FFR and EL. Functional progression was defined as ≥ 0.05 decrease in CT-FFR on the second coronary CT. Models using baseline CT-FFR and EL were compared by analyzing the receiver operating characteristic (ROC) curve.
    Results: Of the 94 vessels evaluated, 25 vessels (27 %) showed functional progression. EL at distal stenosis (EL
    Conclusion: When EL
    Language English
    Publishing date 2023-09-28
    Publishing country United States
    Document type Journal Article
    ISSN 2666-6022
    ISSN (online) 2666-6022
    DOI 10.1016/j.ahjo.2023.100328
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  5. Article ; Online: First validation of stress myocardial perfusion scintigraphy using a novel reconstruction process.

    Kudo, Ayako / Fujimoto, Shinichiro / Aoshima, Chihiro / Kawaguchi, Yuko O / Nozaki, Yui O / Takahashi, Daigo / Takamura, Kazuhisa / Hiki, Makoto / Tomizawa, Nobuo / Murakami, Koji / Aoki, Shigeki / Minamino, Tohru

    Annals of nuclear medicine

    2023  Volume 37, Issue 7, Page(s) 390–399

    Abstract: Background: A new image reconstruction process termed the MUS method (masking process on unsmoothed images) was developed to eliminate artifacts, especially those in the inferior wall. We compared diagnostic performance between the MUS and conventional ... ...

    Abstract Background: A new image reconstruction process termed the MUS method (masking process on unsmoothed images) was developed to eliminate artifacts, especially those in the inferior wall. We compared diagnostic performance between the MUS and conventional method in stress myocardial perfusion SPECT (MPS).
    Methods: Enrolled were 126 patients who underwent stress-rest MPS with
    Results: Sensitivity was comparable between the MUS method and the conventional method (ordered subset expectation maximization; OSEM) (51% vs 54%, respectively; (p = 0.366), specificity was significantly higher using the MUS method (87% vs 77%, respectively; p < 0.05), and diagnostic performance was higher using the MUS method (area under curve [AUC], conventional 0.61 vs. MUS 0.69, p = 0.138). In evaluation of 87 patients after excluding 39 who received additional prone imaging, sensitivity using the MUS method was 44%, which was comparable to 44% using the conventional method but specificity was 90%, which was significantly higher than 77% using the conventional method (p < 0.05). The diagnostic performance of the MUS method was higher (AUC, conventional 0.60 vs. MUS 0.67, p = 0.185).
    Conclusion: Use of the MUS method improved specificity in diagnosis of IHD while maintaining sensitivity, compared with the conventional method. The MUS method can achieve an improvement in diagnostic accuracy equivalent to the supine position, particularly in patients who have difficulty performing the prone position, without increasing the patient burden.
    MeSH term(s) Humans ; Constriction, Pathologic ; Sensitivity and Specificity ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon/methods ; Coronary Angiography ; Myocardial Ischemia/diagnostic imaging ; Perfusion Imaging ; Myocardial Perfusion Imaging/methods ; Coronary Artery Disease/diagnostic imaging
    Chemical Substances Technetium Tc 99m Sestamibi (971Z4W1S09)
    Language English
    Publishing date 2023-04-12
    Publishing country Japan
    Document type Journal Article
    ZDB-ID 1146984-5
    ISSN 1864-6433 ; 0914-7187
    ISSN (online) 1864-6433
    ISSN 0914-7187
    DOI 10.1007/s12149-023-01837-w
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    Zs.A 3657: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  6. Article ; Online: Validation and clinical impact of novel pericoronary adipose tissue measurement on ECG-gated non-contrast chest CT.

    Takahashi, Daigo / Fujimoto, Shinichiro / Nozaki, Yui O / Kudo, Ayako / Kawaguchi, Yuko O / Takamura, Kazuhisa / Hiki, Makoto / Sato, Hideyuki / Tomizawa, Nobuo / Kumamaru, Kanako K / Aoki, Shigeki / Minamino, Tohru

    Atherosclerosis

    2023  Volume 370, Page(s) 18–24

    Abstract: Background and aims: We aimed to develop a method for quantifying pericoronary adipose tissue (PCAT) on electrocardiogram (ECG)-gated non-contrast CT (NC-PCAT) and validate its efficacy and prognostic value.: Methods: We retrospectively studied two ... ...

    Abstract Background and aims: We aimed to develop a method for quantifying pericoronary adipose tissue (PCAT) on electrocardiogram (ECG)-gated non-contrast CT (NC-PCAT) and validate its efficacy and prognostic value.
    Methods: We retrospectively studied two independent cohorts. PCAT was quantified conventionally. NC-PCAT was defined as the mean CT value of epicardial fat tissue adjacent to right coronary artery ostium on ECG-gated non-contrast CT. In cohort 1 (n = 300), we evaluated the correlation of two methods and the association between NC-PCAT and CT-verified high-risk plaque (HRP). We dichotomized cohort 2 (n = 333) by the median of NC-PCAT, and assessed the prognostic value of NC-PCAT for primary endpoint (all-cause death and non-fatal myocardial infarction) by Cox regression analysis. The median duration of follow-up was 2.9 years.
    Results: NC-PCAT was correlated with PCAT (r = 0.68, p<0.0001). In multivariable logistic regression analysis, high NC-PCAT (OR:1.06; 95%CI:1.03-1.10; p = 0.0001), coronary artery calcium score (CACS) (OR:1.01 per 10 CACS increase, 95%CI:1.00-1.02; p = 0.013), and current smoking (OR:2.58; 95%CI:1.03-6.49; p = 0.044) were independent predictors of HRP. Among patients with CACS>0 (n = 193), NC-PCAT (OR:1.06; 95%CI:1.03-1.10; p = 0.0002), current smoking (OR:3.02; 95%CI:1.17-7.82; p = 0.027), and male sex (OR:2.81; 95%CI:1.06-7.48; p = 0.028) were independent predictors of HRP, whereas CACS was not (p = 0.15). Multivariable Cox regression analysis revealed high NC-PCAT as an independent predictor of the primary endpoint, even after adjustment for sex and age (HR:4.3; 95%CI:1.2-15.2; p = 0.012).
    Conclusions: There was a positive correlation between NC-PCAT and PCAT, with high NC-PCAT significantly associated with worse clinical outcome (independent of CACS) as well as presence of HRP.
    MeSH term(s) Humans ; Male ; Coronary Artery Disease/diagnostic imaging ; Coronary Angiography/methods ; Retrospective Studies ; Tomography, X-Ray Computed/methods ; Plaque, Atherosclerotic ; Adipose Tissue/diagnostic imaging ; Electrocardiography ; Computed Tomography Angiography/methods ; Coronary Vessels/diagnostic imaging
    Language English
    Publishing date 2023-01-31
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 80061-2
    ISSN 1879-1484 ; 0021-9150
    ISSN (online) 1879-1484
    ISSN 0021-9150
    DOI 10.1016/j.atherosclerosis.2023.01.021
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    Zs.A 226: Show issues Location:
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  7. Article ; Online: Atypical Shone's Complex Diagnosed at 70 Years Old: Presenting with Double-orifice Mitral Valve, Bicuspid Aortic Valve, and Aortic Coarctation.

    Kaneko, Tomohiro / Miyazaki, Sakiko / Koike, Takuma / Murata, Azusa / Morimoto, Ryoko / Hirose, Kuniaki / Takamura, Kazuhisa / Endo, Daisuke / Amano, Atsushi / Minamino, Tohru

    Internal medicine (Tokyo, Japan)

    2021  Volume 61, Issue 9, Page(s) 1367–1370

    Abstract: Atypical Shone's complex is a rare congenital anomaly involving a left-sided obstructive lesion of two or three cardiovascular levels. A 70-year-old man with dyspnea on exertion was diagnosed with severe aortic stenosis (AS) with a bicuspid valve, ... ...

    Abstract Atypical Shone's complex is a rare congenital anomaly involving a left-sided obstructive lesion of two or three cardiovascular levels. A 70-year-old man with dyspnea on exertion was diagnosed with severe aortic stenosis (AS) with a bicuspid valve, complicated by severe aortic coarctation (CoA) and a double-orifice mitral valve. He underwent surgery for AS and CoA in one session. It is important to search for complicated malformations, even in cases of bicuspid aortic valve found in old age.
    MeSH term(s) Aged ; Aortic Coarctation/diagnosis ; Aortic Coarctation/diagnostic imaging ; Aortic Valve/abnormalities ; Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Bicuspid Aortic Valve Disease ; Coenzyme A ; Heart Defects, Congenital/surgery ; Humans ; Male ; Mitral Valve/abnormalities ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery
    Chemical Substances Coenzyme A (SAA04E81UX)
    Language English
    Publishing date 2021-10-19
    Publishing country Japan
    Document type Case Reports ; Journal Article
    ZDB-ID 32371-8
    ISSN 1349-7235 ; 0021-5120 ; 0918-2918
    ISSN (online) 1349-7235
    ISSN 0021-5120 ; 0918-2918
    DOI 10.2169/internalmedicine.8176-21
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    Zs.A 240: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  8. Article ; Online: Objective Evaluation With Noncontrast Computed Tomography Can Reveal Calcified Plaque Solidity in Peripheral Artery Diseases.

    Ozaki, Dai / Yokoyama, Ken / Miyazaki, Tetsuro / Hirabayashi, Koji / Abe, Hiroshi / Yabe, Kosuke / Kakihara, Midori / Maki, Masaaki / Shimai, Ryosuke / Isogai, Hiroyuki / Ouchi, Shohei / Yasuda, Yuki / Odagiri, Fuminori / Takamura, Kazuhisa / Yaginuma, Kenji / Tokano, Takashi / Iwasaki, Takashi / Kawai, Satoru / Minamino, Toru

    Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

    2023  , Page(s) 15266028231170119

    Abstract: Purpose: The presence of severely calcified plaque remains problematic in endovascular therapy, and no specific endovascular treatment strategy has been established. Estimating plaque solidity before the procedure may help operators penetrate calcified ... ...

    Abstract Purpose: The presence of severely calcified plaque remains problematic in endovascular therapy, and no specific endovascular treatment strategy has been established. Estimating plaque solidity before the procedure may help operators penetrate calcified plaque with a guide wire. The aim of this study was to establish a method of measuring plaque solidity with noncontrast computed tomography (CT).
    Methods: This retrospective, single-center study included consecutive patients who, between October 2020 and July 2022, underwent noncontrast 5 mm and 1 mm CTs before endovascular therapy to penetrate calcified plaque with a wire in the common femoral, superficial femoral, and popliteal arteries. Three cross-sectional CT slices were selected. To target a calcified plaque lesion, the operator identified a region of interest, which corresponded to 24×24 pixels, and Hounsfield unit (HU) values of each pixel were displayed on the CT image. The average HU values and the ratio of number of pixels of lower values (130-599 HU) represented plaque solidity. We used the Mann-Whitney-Wilcoxon rank-sum test and the chi-square test to compare the solidity of plaques penetrated and not penetrated by the wire.
    Results: We evaluated 108 images of 36 calcified plaque lesions (in 19 patients). The wire penetrated 28 lesions (77.8%) successfully. The average HU value was significantly lower in the lesions that the wire penetrated than in the others, in both the 5 mm CT slices (434.7±86.8 HU vs 554.3±112.7 HU, p=0.0174) and 1 mm slices (497.8±103.1 HU vs 593.5±114.5 HU, p=0.0381). The receiver operating curve revealed that 529.9 and 533.9 HU in the 5 and 1 mm slices, respectively, were the highest values at which wires could penetrate. Moreover, at the lesions that were penetrates successfully, the ratio of number of lower HU value pixels was significantly higher both in 5 mm slice CTs (74.7±13.4 vs 61.7±13.1%, p=0.0347) and 1 mm (68.7±11.8 vs 57.1±11.4%, p=0.0174).
    Conclusion: The use of noncontrast CT to evaluate plaque solidity was associated with successful wire penetration of calcified lesions in peripheral arteries.
    Clinical impact: This study revealed an association between the wire penetration inside calcified plaque and plaque solidity estimated using non-contrasted computed tomography. The mean Hounsfield unit values of three cross-sections in calcified plaques were associated with the successful wire penetration. This wire penetration difficulty is associated with extended procedure time, excessive radiation exposure, usage of extra contrast agents, and increased medical costs. Therefore, estimating calcified plaque solidity before procedure enables us to choose effective and lean procedures. In addition, to predict the success of dilating calcified plaque from the inside is also beneficial when the operator wants to avoid extra scaffold implantation for target lesions.
    Language English
    Publishing date 2023-05-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2006618-1
    ISSN 1545-1550 ; 1526-6028
    ISSN (online) 1545-1550
    ISSN 1526-6028
    DOI 10.1177/15266028231170119
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    Zs.A 4547: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  9. Article: Impact of bystander cardiopulmonary resuscitation on neurological outcomes in patients undergoing veno-arterial extracorporeal membrane oxygenation.

    Shimai, Ryosuke / Ouchi, Shohei / Miyazaki, Tetsuro / Hirabayashi, Koji / Abe, Hiroshi / Yabe, Kosuke / Kakihara, Midori / Maki, Masaaki / Isogai, Hiroyuki / Wada, Takeshi / Ozaki, Dai / Yasuda, Yuki / Odagiri, Fuminori / Takamura, Kazuhisa / Yaginuma, Kenji / Yokoyama, Ken / Tokano, Takashi / Minamino, Tohru

    International journal of emergency medicine

    2023  Volume 16, Issue 1, Page(s) 8

    Abstract: Background: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) requires a large amount of economic and human resources. The presence of bystander cardiopulmonary resuscitation (CPR) was focused on selecting appropriate V-A ECMO candidates.: ... ...

    Abstract Background: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) requires a large amount of economic and human resources. The presence of bystander cardiopulmonary resuscitation (CPR) was focused on selecting appropriate V-A ECMO candidates.
    Result: This study retrospectively enrolled 39 patients with V-A ECMO due to out-of-hospital cardiac arrest (CA) between January 2010 and March 2019. The introduction criteria of V-A ECMO included the following: (1) < 75 years old, (2) CA on arrival, (3) < 40 min from CA to hospital arrival, (4) shockable rhythm, and (5) good activity of daily living (ADL). The prescribed introduction criteria were not met by 14 patients, but they were introduced to V-A ECMO at the discretion of their attending physicians and were also included in the analysis. Neurological prognosis at discharge was defined using The Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories of Brain Function (CPC). Patients were divided into good or poor neurological prognosis (CPC ≤ 2 or ≥ 3) groups (8 vs. 31 patients). The good prognosis group had a significantly larger number of patients who received bystander CPR (p = 0.04). The mean CPC at discharge was compared based on the combination with the presence of bystander CPR and all five original criteria. Patients who received bystander CPR and met all original five criteria showed significantly better CPC than patients who did not receive bystander CPR and did not meet some of the original five criteria (p = 0.046).
    Conclusion: Considering the presence of bystander CPR help in selecting the appropriate candidate of V-A ECMO among out-of-hospital CA cases.
    Language English
    Publishing date 2023-02-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2411462-5
    ISSN 1865-1380 ; 1865-1372
    ISSN (online) 1865-1380
    ISSN 1865-1372
    DOI 10.1186/s12245-023-00485-1
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  10. Article ; Online: Use of a deep-learning-based lumen extraction method to detect significant stenosis on coronary computed tomography angiography in patients with severe coronary calcification.

    Inage, Hidekazu / Tomizawa, Nobuo / Otsuka, Yujiro / Aoshima, Chihiro / Kawaguchi, Yuko / Takamura, Kazuhisa / Matsumori, Rie / Kamo, Yuki / Nozaki, Yui / Takahashi, Daigo / Kudo, Ayako / Hiki, Makoto / Kogure, Yosuke / Fujimoto, Shinichiro / Minamino, Tohru / Aoki, Shigeki

    The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology

    2022  Volume 74, Issue 1, Page(s) 43

    Abstract: Background: Coronary computed tomography angiography examinations are increasingly becoming established as a minimally invasive method for diagnosing coronary diseases. However, although various imaging and processing methods have been developed, ... ...

    Abstract Background: Coronary computed tomography angiography examinations are increasingly becoming established as a minimally invasive method for diagnosing coronary diseases. However, although various imaging and processing methods have been developed, coronary artery calcification remains a major limitation in the evaluation of the vascular lumen. Subtraction coronary computed tomography angiography (Sub-CCTA) is a method known to be able to reduce the influence of coronary artery calcification and is therefore feasible for improving the diagnosis of significant stenosis in patients with severe calcification. However, Sub-CCTA still involves some problems, such as the increased radiation dose due to plain (mask) imaging, extended breath-holding time, and misregistration due to differences in the imaging phase. Therefore, we considered using artificial intelligence instead of Sub-CCTA to visualize the coronary lumen with high calcification. Given this background, the present study aimed to evaluate the diagnostic performance of a deep learning-based lumen extraction method (DL-LEM) to detect significant stenosis on CCTA in 99 consecutive patients (891 segments) with severe coronary calcification from November 2015 to March 2018. We also estimated the impact of DL-LEM on the medical economics in Japan.
    Results: The DL-LEM slightly improved the per-segment diagnostic accuracy from 74.5 to 76.4%, and the area under the curve (AUC) slightly improved from 0.752 to 0.767 (p = 0.030). When analyzing the 228 segments that could not be evaluated because of severe calcification on the original CCTA images, the DL-LEM improved the accuracy from 35.5 to 42.5%, and the AUC improved from 0.500 to 0.587 (p = 0.00018). As a result, DL-LEM analysis could have avoided invasive coronary angiography in 4/99 cases (per patient). From the calculated results, it was estimated that the number of exams that can be avoided in Japan in one year is approximately 747 for invasive coronary angiography, 219 for fractional flow reserve, and 248 for nuclear exam. The total amount of medical fee that could be reduced was 225,629,368 JPY.
    Conclusions: These findings suggest that the DL-LEM may improve the diagnostic performance in detecting significant stenosis in patients with severe coronary calcification. In addition, the results suggest that not a small medical economic effect can be expected.
    Language English
    Publishing date 2022-05-21
    Publishing country Germany
    Document type Journal Article
    ISSN 2090-911X
    ISSN (online) 2090-911X
    DOI 10.1186/s43044-022-00280-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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