Sarcopenia is a loss of muscle mass and function [1]. This phenomenon occurs not only in elderly people but also in patients with chronic illnesses such as, chronic heart failure (HF), liver dysfunction, and kidney dysfunction [1-5], which is called secondary sarcopenia. Possible explanations for sarcopenia include an abnormal energy metabolism coupled with mitochondrial dysfunction as well as a change in the structure of the myofibers, malnutrition, systemic inflammation, and oxidative stress [6][7][8][9].Recent studies have reported that secondary sarcopenia is not rare in adults with congenital heart disease (CHD) [10,11]. Sarcopenia is one of the important predictors of HF in non-CHD [12][13][14]; whereas, it remains unclear whether sarcopenia is also relevant to prognosis in adults with CHD. In particular, skeletal muscle function is important in Fontan circulation because a passive blood flow in a Fontan route can be maintained by both skeletal muscle pumping and the change of intrapleural pressure (ventilatory pumping) [15][16][17]. However, it is challenging to measure the entire skeletal muscle mass; until now, dual energy X-ray absorptiometry or bioelectrical impedance analysis (BIA) has been used to measure it [1,2]. The former method needs special equipment, and the latter is not available to patients after pacemaker implantation. The biggest issue in adults with Fontan circulation is that most patients have already undergone pacemaker implantation; therefore,
A reduced vortex flow in the RA during the late phase of the Fontan operation was associated with the development of FALD. MVF can be used as an imaging biomarker to predict FALD.
Objective: A 320-row multidetector CT (MDCT) is expected for a good artery-vein separation in terms of temporal resolution. However, a shortened scan duration may lead to insufficient vascular enhancement. We assessed the optimal scan timing for the artery-vein separation at whole-brain CT angiography (CTA) when bolus tracking was used at 320-row MDCT. Methods: We analyzed 60 patients, who underwent whole-brain four-dimensional CTA. Difference in CT attenuation between the internal carotid artery (ICA) and the superior sagittal sinus (D att ) was calculated in each phase. Using a visual evaluation score for the depiction of arteries and veins, we calculated the difference between the mean score for the intracranial arteries and the mean score for the veins (D score ). We assessed the time at which the maximum D att and D score were simultaneously observed. Results: The maximum D att was observed at 6.0 s and 8.0 s in the arterial-dominant phase and at 16.0 s and 18.0 s in the venous-dominant phase after the contrast media arrival time at the ICA (T aa ). The maximum D score was observed at 6.0 s and 8.0 s in the arterial-dominant phase and at 16.0 s in the venous-dominant phase after the T aa . There were no statistically significant differences in D att (p 5 0.375) or D score (p 5 0.139) between these scan timings. Conclusion: The optimal scan timing for artery-vein separation at whole-brain CTA was 6.0 s or 8.0 s for the arteries and 16.0 s for the veins after the T aa . Advances in knowledge: Optimal scan timing allowed us to visualize intracranial arteries or veins with minimal superimposition.
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