Publications
Department of Medicine faculty members published more than 3,000 peer-reviewed articles in 2022.
2018
2018
2018
PURPOSE
To develop and evaluate a simultaneous multislice (SMS) spiral perfusion pulse sequence with whole-heart coverage.
METHODS
An orthogonal set of phase cycling angles following a Hadamard pattern was incorporated into a golden-angle (GA) variable density spiral perfusion sequence to perform SMS imaging at different multiband (MB) factors. Images were reconstructed using an SMS extension of L1-SPIRiT that we have termed SMS-L1-SPIRiT. The proposed sequence was evaluated in 40 subjects (10 each for MB factors of 1, 2, 3, and 4). Images were blindly graded by 2 cardiologists on a 5-point scale (5, excellent). To quantitatively evaluate the reconstruction performance against images acquired without SMS, the MB =1 data were used to retrospectively simulate data acquired at MB factors of 2 to 4.
RESULTS
Analysis of the SMS point-spread function for the desired slice showed that the proposed sampling strategy significantly canceled the main-lobe energy of the other slices and has low side-lobe energy resulting in an incoherent temporal aliasing pattern when rotated by the GA. Retrospective experiments demonstrated the SMS-L1-SPIRiT method removed aliasing from the interfering slices and showed excellent agreement with the ground-truth MB =1 images. Clinical evaluation demonstrated high-quality perfusion images with average image-quality scores of 4.3 ± 0.5 (MB =2), 4.2 ± 0.5 (MB =3), and 4.4 ± 0.4 (MB =4) with no significant quality difference in image quality between MB factors (P = 0.38).
CONCLUSION
SMS spiral perfusion at MB factors 2, 3, and 4 produces high-quality perfusion images with whole-heart coverage in a clinical setting with high sampling efficiency.
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2018
2018
2018
2018
AIMS
Out of Hospital Cardiac Arrest (OHCA) is frequently attributed to coronary artery disease, thus guidelines recommend coronary angiography (CAG) for survivors of OHCA. However, the real-world application of these guidelines is unknown, and we sought to evaluate CAG practices in the contemporary OHCA population.
METHODS
The Clinical Outcomes Assessment Program (COAP), a Washington State public reporting system, and the Cardiac Arrest Registry to Enhance Survival (CARES), a national registry of OHCA, were matched to characterize OHCA presentations between 2014 and 2015. Adults presenting to PCI-capable centers after OHCA were included. Logistic regression analyses were performed to assess predictors of undergoing CAG after OHCA.
RESULTS
2361 subjects were included with 729 (31%) proceeding to CAG, and 354 (15%) receiving PCI. The majority had return of spontaneous circulation (ROSC) at hospital arrival without identified ST elevations (72.2%). Of those with ST elevations and ROSC, 69% underwent CAG. OHCAs without ST elevations underwent CAG in 29.6% and PCI in 12.6%. After adjustment, older patients (aOR 0.73, 95% CI 0.72-0.84 per decade) and women (aOR 0.53, 95% CI 0.41-0.67) were less likely to proceed to CAG. Patients with witnessed arrest (aOR 2.07, 95% CI 1.62-2.67), VT/VF (aOR 6.11, 95% CI 4.85-7.69), ST elevations (aOR 3.82, 95% CI 2.71-5.38) and sustained ROSC (aOR 3.64, 95% CI 2.62-5.04) were more likely to undergo CAG.
CONCLUSION
Only one-third of patients presenting to PCI-capable hospitals underwent CAG after OHCA. Patient selection for an invasive strategy after OHCA appeared to be heavily influenced by pre-hospital presentation variables.
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